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

OBJECTIVE
To identify if 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 (ACS) National Surgical Quality Improvement Program (NSQIP) database.


PATIENTS
Patients in the NSQIP database with periprosthetic hip or knee fractures between 2007-2015 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 following 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 (RR = 2.90 (95% CI = 1.74 - 4.71); p-value = <0.001) and risk factor for increased 30-day mortality (RR = 8.98 (95% CI: 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 co-morbidities. While 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.