Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures
Background: Renal osteodystrophy predisposes renal disease patients to fracture. Proximal humerus fractures (PHFs) frequently undergo open reduction internal fixation (ORIF); however, the effect of renal disease on outcomes is unknown. Methods: A retrospective review of the Nationwide Readmissions D...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638322001323 |
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| author | Seth Ahlquist, MD Peter P. Hsiue, MD Clark J. Chen, MD Brendan Shi, MD Alexander Upfill-Brown, MD Ben V. Kelley, MD Peyman Benharash, MD Christos Photopoulos, MD Alexandra I. Stavrakis, MD |
| author_facet | Seth Ahlquist, MD Peter P. Hsiue, MD Clark J. Chen, MD Brendan Shi, MD Alexander Upfill-Brown, MD Ben V. Kelley, MD Peyman Benharash, MD Christos Photopoulos, MD Alexandra I. Stavrakis, MD |
| author_sort | Seth Ahlquist, MD |
| collection | DOAJ |
| description | Background: Renal osteodystrophy predisposes renal disease patients to fracture. Proximal humerus fractures (PHFs) frequently undergo open reduction internal fixation (ORIF); however, the effect of renal disease on outcomes is unknown. Methods: A retrospective review of the Nationwide Readmissions Database used International Classification of Diseases, 9th Revision, codes to identify patients who underwent ORIF for closed PHF from 2010 to 2014 with no renal disease, predialysis chronic renal disease (CRD), and end-stage renal disease (ESRD). Results: A total of 85,433 patients were identified, including 5498 (6.4%) CRD and 636 (0.7%) ESRD. CRD and ESRD patients had increased age, comorbidities, and rates of Medicare insurance. After adjusting for differences, CRD and ESRD patients were at increased risk of any complication (odds ratio [OR] 2.48, 1.66), blood transfusion (OR 1.85, 3.31), respiratory complications (OR 1.14, 1.59), acute renal failure (OR 4.80, 1.67), systemic infection (OR 2.00, 3.14), surgical site infection (OR 1.52, 3.87), longer length of stay (7.1 and 12.9 days vs. 5.9 days), and higher cost ($21,669 and $35,413 vs. $20,394) during index hospitalization, as well as surgical site infection (OR 1.43, 3.03) and readmission (OR 1.61, 3.69) within 90 days of discharge, respectively, compared with no renal disease patients. During index hospitalization, CRD patients also had increased risk for periprosthetic fracture (OR 4.97) and cardiac complications (OR 1.47), whereas ESRD patients had increased risk of mortality (OR 5.79), wound complication (2.67), and deep vein thrombosis (OR 16.70). Conclusion: These findings suggest renal patients are at increased risk for complications after PHF ORIF, highlighting the importance of close perioperative monitoring and appropriate patient selection in this population, including strong consideration of nonoperative management. |
| first_indexed | 2024-12-10T18:07:20Z |
| format | Article |
| id | doaj.art-a4ed5d38c138462bad16207668a1d834 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-12-10T18:07:20Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-a4ed5d38c138462bad16207668a1d8342022-12-22T01:38:35ZengElsevierJSES International2666-63832022-09-0165736742Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fracturesSeth Ahlquist, MD0Peter P. Hsiue, MD1Clark J. Chen, MD2Brendan Shi, MD3Alexander Upfill-Brown, MD4Ben V. Kelley, MD5Peyman Benharash, MD6Christos Photopoulos, MD7Alexandra I. Stavrakis, MD8Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USADepartment of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USAKerlan-Jobe Orthopaedic Institute, Los Angeles, CA, USADepartment of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Santa Monica, CA, USA; Corresponding author: Alexandra I. Stavrakis, MD, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1250 16th Street, Suite 2100, Santa Monica, CA 90404, USA.Background: Renal osteodystrophy predisposes renal disease patients to fracture. Proximal humerus fractures (PHFs) frequently undergo open reduction internal fixation (ORIF); however, the effect of renal disease on outcomes is unknown. Methods: A retrospective review of the Nationwide Readmissions Database used International Classification of Diseases, 9th Revision, codes to identify patients who underwent ORIF for closed PHF from 2010 to 2014 with no renal disease, predialysis chronic renal disease (CRD), and end-stage renal disease (ESRD). Results: A total of 85,433 patients were identified, including 5498 (6.4%) CRD and 636 (0.7%) ESRD. CRD and ESRD patients had increased age, comorbidities, and rates of Medicare insurance. After adjusting for differences, CRD and ESRD patients were at increased risk of any complication (odds ratio [OR] 2.48, 1.66), blood transfusion (OR 1.85, 3.31), respiratory complications (OR 1.14, 1.59), acute renal failure (OR 4.80, 1.67), systemic infection (OR 2.00, 3.14), surgical site infection (OR 1.52, 3.87), longer length of stay (7.1 and 12.9 days vs. 5.9 days), and higher cost ($21,669 and $35,413 vs. $20,394) during index hospitalization, as well as surgical site infection (OR 1.43, 3.03) and readmission (OR 1.61, 3.69) within 90 days of discharge, respectively, compared with no renal disease patients. During index hospitalization, CRD patients also had increased risk for periprosthetic fracture (OR 4.97) and cardiac complications (OR 1.47), whereas ESRD patients had increased risk of mortality (OR 5.79), wound complication (2.67), and deep vein thrombosis (OR 16.70). Conclusion: These findings suggest renal patients are at increased risk for complications after PHF ORIF, highlighting the importance of close perioperative monitoring and appropriate patient selection in this population, including strong consideration of nonoperative management.http://www.sciencedirect.com/science/article/pii/S2666638322001323Proximal humerus fractureOpen reduction internal fixationChronic renal diseaseEnd-stage renal diseaseDialysisReadmission |
| spellingShingle | Seth Ahlquist, MD Peter P. Hsiue, MD Clark J. Chen, MD Brendan Shi, MD Alexander Upfill-Brown, MD Ben V. Kelley, MD Peyman Benharash, MD Christos Photopoulos, MD Alexandra I. Stavrakis, MD Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures JSES International Proximal humerus fracture Open reduction internal fixation Chronic renal disease End-stage renal disease Dialysis Readmission |
| title | Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures |
| title_full | Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures |
| title_fullStr | Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures |
| title_full_unstemmed | Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures |
| title_short | Renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures |
| title_sort | renal disease is a risk factor for complications and mortality after open reduction internal fixation of proximal humerus fractures |
| topic | Proximal humerus fracture Open reduction internal fixation Chronic renal disease End-stage renal disease Dialysis Readmission |
| url | http://www.sciencedirect.com/science/article/pii/S2666638322001323 |
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