Is Timing to Surgery an Independent Risk Factor for Complications Following Operative Treatment of Periprosthetic Lower Extremity Fractures?

OBJECTIVE

To identify whether timing to surgery was related to major 30-day morbidity and mortality rates in periprosthetic hip and knee fractures [OTA/AO 3 (IV.3, V.3), OTA/AO 4 (V4)].

DESIGN

Retrospective database review.

SETTING

Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database.

PATIENTS: Patients in the NSQIP database with periprosthetic hip or knee fractures between 2007 and 2015.

INTERVENTION: Surgical management of periprosthetic hip and knee fractures including revision or open reduction internal fixation.

MAIN OUTCOME MEASUREMENTS: Major 30-day morbidity and mortality after operative treatment of periprosthetic hip or knee fractures.

RESULTS

A total of 1265 patients, mean age 72, including 883 periprosthetic hip and 382 periprosthetic fractures about the knee were reviewed. Delay in surgery greater than 72 hours is a risk factor for increased 30-day morbidity in periprosthetic hip and knee fractures [relative risk = 2.90 (95% confidence interval: 1.74-4.71); P-value ≤ 0.001] and risk factor for increased 30-day mortality [relative risk = 8.98 (95% confidence interval: 2.14-37.74); P-value = 0.003].

CONCLUSIONS

Using NSQIP database to analyze periprosthetic hip and knee fractures, delay to surgery is an independent risk factor for increased 30-day major morbidity and mortality when controlling for patient functional status and comorbidities. Although patient optimization and surgical planning are paramount, minimizing extended delays to surgery is a potentially modifiable risk factor in the geriatric periprosthetic lower extremity fracture patient.

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