Complications after operatively treated fractures in patients with solid organ transplantation - A systematic review of the literature.

INTRODUCTION

Solid organ transplantation is associated with multiple risk factors, reduced bone quality and relevant comorbidities, which may negatively affect postoperative outcomes after fracture treatment. Furthermore, these patients usually require lifelong immunosuppressive therapy. A systematic review was performed to evaluate the incidence of postoperative complications and to assess whether specific considerations are required in this special patient group.

METHODS

A systematic review of the literature according to the PRISMA guidelines was performed. A total of 3743 studies were identified and subsequently assessed for eligibility. Studies investigating elective orthopedic procedures were excluded. After full-text screening, six studies were included in the final analysis.

RESULTS

Overall, the six studies investigated 2317 patients. Cohort sizes ranged from 12 to 2163 patients, with a median cohort size of 33.5 patients. Mean age of patients was 67.9 years. Follow-up durations varied between 18 weeks and 3 years. The most frequently investigated fracture type was proximal femoral fractures with three studies, followed by lower extremity fractures (two studies). One study examined distal radius fractures. Infectious complications were reported in four studies, with a pooled infection rate of 10%. The pooled 90-day readmission rate was 20%. Mortality was reported heterogeneously across studies, ranging from 2% to 52%.

CONCLUSION

Studies investigating outcomes after operatively treated fractures in solid organ transplant recipients are rare. Interestingly, infectious complication rates and 90-day readmission rates do not appear to be substantially increased compared to the general population. The wide range of reported mortality rates is likely attributable to differences in fracture types and patient populations, as certain fractures-such as femoral neck fractures-are associated with high mortality even in non-transplanted patients.