Delays to fracture stabilization and the effect on postoperative outcomes: A retrospective cohort study of 211 canine humeral condylar fractures.

OBJECTIVE

To investigate the effect of surgical delay on radiographic and patient outcomes following canine humeral condylar fracture stabilization.

STUDY

DESIGN

Retrospective observational cohort study.

SAMPLE POPULATION: A total of 211humeral condylar fractures (204 dogs).

METHODS

Time to surgery and clinical data were collected from the medical record. Immediate postoperative radiographs were reviewed for an intracondylar gap or articular step defect. Postoperative complications and short-term outcome data were collected with a minimum 28-day follow-up period. Multivariable logistic regression analysis modeled radiographic and patient outcomes.

RESULTS

Fracture events occurring on Friday or Saturday were systematically associated with longer delays to surgery (p < .001). Increasing delays to surgery were associated with an increased risk of an intracondylar gap or articular step defect on immediate postoperative radiographs (adjusted OR = 3.86 per additional day, 95% CI: 2.04-7.29, p < .001). Presence of an intracondylar gap or articular step defect was associated with an increased risk of postoperative complications (adjusted OR = 5.92, 95% CI: 1.44-24.36, p = .01). Presence of an intracondylar gap or articular step defect was associated with an increased risk of a poorer short-term outcome (adjusted OR = 0.13, 95% CI: 0.04-0.42, p = .001). The presence of postoperative complications increased the risk of a poorer short-term outcome (adjusted OR = 0.38, 95% CI: 0.17-0.87, p = .02).

CONCLUSION

Delays to surgery are an important system-level factor influencing the accuracy of fracture reduction, postoperative complications, and short-term outcomes in canine humeral condylar fracture repair.

CLINICAL SIGNIFICANCE: System-level optimization may be an avenue for quality improvement in this patient population.