Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures
Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 Amer...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-05-01
|
| Series: | Geriatric Orthopaedic Surgery & Rehabilitation |
| Online Access: | https://doi.org/10.1177/21514593211011462 |
| _version_ | 1818675326525374464 |
|---|---|
| author | Mitchell T. Gray BS Krystin A. Hidden MD Azeem T. Malik MBBS Safdar N. Khan MD Laura Phieffer MD Thuan V. Ly MD Carmen E. Quatman MD, PhD |
| author_facet | Mitchell T. Gray BS Krystin A. Hidden MD Azeem T. Malik MBBS Safdar N. Khan MD Laura Phieffer MD Thuan V. Ly MD Carmen E. Quatman MD, PhD |
| author_sort | Mitchell T. Gray BS |
| collection | DOAJ |
| description | Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population. |
| first_indexed | 2024-12-17T08:25:48Z |
| format | Article |
| id | doaj.art-aac264a137d84ebda166ff1ac9ad66b7 |
| institution | Directory Open Access Journal |
| issn | 2151-4593 |
| language | English |
| last_indexed | 2024-12-17T08:25:48Z |
| publishDate | 2021-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Geriatric Orthopaedic Surgery & Rehabilitation |
| spelling | doaj.art-aac264a137d84ebda166ff1ac9ad66b72022-12-21T21:56:46ZengSAGE PublishingGeriatric Orthopaedic Surgery & Rehabilitation2151-45932021-05-011210.1177/21514593211011462Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle FracturesMitchell T. Gray BS0Krystin A. Hidden MD1Azeem T. Malik MBBS2Safdar N. Khan MD3Laura Phieffer MD4Thuan V. Ly MD5Carmen E. Quatman MD, PhD6 , Indianapolis, IN, USA Department of Orthopedics, , Columbus, OH, USA Department of Orthopedics, , Columbus, OH, USA Department of Orthopedics, , Columbus, OH, USA Department of Orthopedics, , Columbus, OH, USA Department of Orthopedics, , Columbus, OH, USA Department of Orthopedics, , Columbus, OH, USAIntroduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.https://doi.org/10.1177/21514593211011462 |
| spellingShingle | Mitchell T. Gray BS Krystin A. Hidden MD Azeem T. Malik MBBS Safdar N. Khan MD Laura Phieffer MD Thuan V. Ly MD Carmen E. Quatman MD, PhD Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures Geriatric Orthopaedic Surgery & Rehabilitation |
| title | Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures |
| title_full | Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures |
| title_fullStr | Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures |
| title_full_unstemmed | Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures |
| title_short | Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures |
| title_sort | octogenarian and nonagenarians are at a higher risk for experiencing adverse 30 day outcomes following orif of ankle fractures |
| url | https://doi.org/10.1177/21514593211011462 |
| work_keys_str_mv | AT mitchelltgraybs octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures AT krystinahiddenmd octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures AT azeemtmalikmbbs octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures AT safdarnkhanmd octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures AT lauraphieffermd octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures AT thuanvlymd octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures AT carmenequatmanmdphd octogenarianandnonagenariansareatahigherriskforexperiencingadverse30dayoutcomesfollowingorifofanklefractures |