Is the "Fix-and-Replace" Method Associated With Higher Early Perioperative Risk Than Isolated Internal Fixation for Acetabular Fractures in Frail Patients?

OBJECTIVES

To examine the impact of frailty on 30-day outcomes of open reduction internal fixation (ORIF) alone or ORIF + total hip arthroplasty (THA) (fix-and-replace) for the treatment of acetabular fractures.

DESIGN

Retrospective Cohort.

SETTING

A total of 700 hospitals in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

PATIENT SELECTION CRITERIA: Included were patients aged 60 years or older undergoing ORIF ± THA for OTA/AO type 62 A-C fractures from 2015 to 2020.

OUTCOME MEASURES AND COMPARISONS: Preoperative frailty was assessed by the revised Risk Analysis Index (not frail: <21, prefrail: 21-30, frail: 31-40, severely frail: >40) and the 5-Item Modified Frailty Index factor. All outcome measures were in-hospital or within 30 days postoperatively, including the "favorable outcome," defined as no readmission, length of stay (LOS) < cohort median, and no major complication or death.

RESULTS

There were 585 patients included [ORIF (88%): mean age-70.5 ± 14.2, sex-41.4% female; ORIF + THA (12%): mean age-77.0 ± 13.4; sex-65.7% female]. Frail patients (n = 353, 65.5%) were more likely to experience a complication [OR: 3.31, CI: (1.83-5.96)] and mortality (3.7% vs. 0.0%). ORIF + THA had higher association with postoperative transfusion [OR: 2.70, CI: (1.63-4.48)] but lower association with LOS >3 days [OR: 0.41, CI: (0.24-0.72)] and nonhome discharge [OR: 0.52, CI: (0.27-0.98)] than ORIF. Prefrail and frail patients undergoing ORIF + THA were more likely to achieve favorable outcomes than those nonfrail or severely frail [OR: 9.69, (3.40-27.57)].

CONCLUSIONS

Surgical intervention for acetabular fractures carried a 30-day complication risk of 12%-19% for frail patients. Frailty had similar predictability to age for early morbidity after surgery to treat acetabular fractures. Open reduction and internal fixation with the addition of an acute THA was associated with a higher rate of blood transfusion and shorter hospital LOS in frail patients with acetabular fractures.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.