Citation

Frane N, Iturriaga C, Bub C, Regala P, Katsigiorgis G, Linn M. J. Clin. Orthop. Trauma 2020; 11(6): 1110-1116.

Copyright

(Copyright © 2020, Elsevier Publishing)

DOI

10.1016/j.jcot.2020.08.017

PMID

33192016 PMCID

Abstract

BACKGROUND: Open pelvic fractures are rare injuries, associated with high patient morbidity and mortality. Few studies have investigated the impact of patient demographics, comorbidities, and injury related factors on complication and mortality rates. The purpose of this study was to: (1) identify the overall incidence of complications and mortality after open pelvic fractures, (2) compare patient factors between those who did and did not develop complications, (3) identify perioperative independent risk factors for complications and mortality.

Methods: A query was performed for patients with open pelvic fractures between 2007 and 2017 using the American College of Surgeons National Trauma Data Bank. Patient and injury specific variables were collected and complications were identified using International Classification of Disease Ninth and Tenth edition Codes. Patient demographic and perioperative data was compared using Fisher's exact test and chi-square test for categorical variables, and Welch's t-test for continuous variables. Using pooled data from multiple imputations, logistic regressions were used to calculate odds ratios and confidence intervals of independent risk factors for complications.

Results: A total of 19,834 open pelvic fracture cases were identified, with 9622 patients (48.5%) developing at least one complication. Patients who developed complications were older (35.0 vs 38.1 years), and had higher Injury Severity Scores (17.7 vs 26.5), lower Glasgow Coma Scores (14.2 vs 11.7), and a larger proportion presenting with hypotension (21% vs 6.9%). After pooled regression involving 19 factors, these were the strongest independent predictors of inpatient complication and mortality.

Conclusion: We report a mortality rate of 14%, with an inclusive complication rate of 48.5%. Evaluating risk factors for morbidity and mortality for this devastating orthopaedic injury provides knowledge of an inherently sparse population.

Level of Evidence: Level II, Retrospective study.

Language: en

Keywords

Epidemiology; ACS-NTDB, American College of Surgeons National Trauma Data Bank; ACS, American College of Surgeons; AIS, Abbreviated Injury Scale; BP, blood pressure; E-Code, external cause of injury; ED, Emergency Department; GCS, Glasgow Coma Scale; ICD-10, International Classification of Disease Tenth; ICD-9, International Classification of Disease Ninth; ISS, Injury Severity Score; MCAR, missing completely at random; National trauma data bank; NTDB; Open pelvic fractures; Orthopaedic surgery; Orthopaedic trauma; PE, pulmonary embolism; Pelvic fractures; RTS, Revised Trauma Score; SBP, systolic blood pressure; UTI, urinary tract infection