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Predictors of 30-day mortality following hip/pelvis fractures.
Orthop Traumatol Surg Res. 2016 10; 102(6):707-10.OT

Abstract

INTRODUCTION

With the cost of healthcare in the United States reaching $2.9 trillion in 2013 and expected to increase with a growing geriatric population, the Center for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality rates so that hospitals and physicians may begin to confront clinical problems and promote high-quality and patient-centered care. Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures. Therefore, in this study, we sought to explore the risk factors associated with 30-day mortality in trauma-related hip and pelvic fractures.

MATERIALS AND METHODS

Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 341,062 patients undergoing orthopaedic procedures from 2005 to 2013 were identified through a Current Procedural Terminology (CPT) code search. A second CPT code search identified 24,805 patients who sustained a hip/pelvis fracture. Patient demographics, preoperative comorbidities, operative characteristics and postoperative complications were collected and compared using Chi-squared test, Wilcoxon-Mann-Whitney test and multivariate logistic regression analysis.

RESULTS

Preoperative and postoperative risk factors for 30-day mortality following a hip/pelvis fracture were found: ASA classification, ascites, disseminated cancer, dyspnea, functional status, history of congestive heart failure (CHF), history of chronic obstructive pulmonary disease (COPD), a recent blood transfusion, and the postoperative complications: pneumonia, myocardial infarction, stroke, and septic shock.

DISCUSSION

Several preoperative patient risk factors and postoperative complications greatly increased the odds for patient mortality following 30-days after initial surgery. Orthopaedic surgeons can utilize these predictive risk factors to better improve patient care.

LEVEL OF EVIDENCE

Retrospective study. Level IV.

Authors+Show Affiliations

The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA.The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232, USA. Electronic address: Manish.sethi@vanderbilt.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27496661

Citation

Dodd, A C., et al. "Predictors of 30-day Mortality Following Hip/pelvis Fractures." Orthopaedics & Traumatology, Surgery & Research : OTSR, vol. 102, no. 6, 2016, pp. 707-10.
Dodd AC, Bulka C, Jahangir A, et al. Predictors of 30-day mortality following hip/pelvis fractures. Orthop Traumatol Surg Res. 2016;102(6):707-10.
Dodd, A. C., Bulka, C., Jahangir, A., Mir, H. R., Obremskey, W. T., & Sethi, M. K. (2016). Predictors of 30-day mortality following hip/pelvis fractures. Orthopaedics & Traumatology, Surgery & Research : OTSR, 102(6), 707-10. https://doi.org/10.1016/j.otsr.2016.05.016
Dodd AC, et al. Predictors of 30-day Mortality Following Hip/pelvis Fractures. Orthop Traumatol Surg Res. 2016;102(6):707-10. PubMed PMID: 27496661.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictors of 30-day mortality following hip/pelvis fractures. AU - Dodd,A C, AU - Bulka,C, AU - Jahangir,A, AU - Mir,H R, AU - Obremskey,W T, AU - Sethi,M K, Y1 - 2016/08/03/ PY - 2015/11/18/received PY - 2016/05/12/revised PY - 2016/05/30/accepted PY - 2016/8/7/entrez PY - 2016/8/9/pubmed PY - 2017/10/3/medline KW - 30-day mortality KW - Complications KW - Hip fracture KW - Pelvis fracture KW - Risk factors SP - 707 EP - 10 JF - Orthopaedics & traumatology, surgery & research : OTSR JO - Orthop Traumatol Surg Res VL - 102 IS - 6 N2 - INTRODUCTION: With the cost of healthcare in the United States reaching $2.9 trillion in 2013 and expected to increase with a growing geriatric population, the Center for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) began publicly reporting 30-day mortality rates so that hospitals and physicians may begin to confront clinical problems and promote high-quality and patient-centered care. Though the 30-day mortality is considered a highly effective tool in measuring hospital performance, little data actually exists that explores the rate and risk factors for trauma-related hip and pelvis fractures. Therefore, in this study, we sought to explore the risk factors associated with 30-day mortality in trauma-related hip and pelvic fractures. MATERIALS AND METHODS: Utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, 341,062 patients undergoing orthopaedic procedures from 2005 to 2013 were identified through a Current Procedural Terminology (CPT) code search. A second CPT code search identified 24,805 patients who sustained a hip/pelvis fracture. Patient demographics, preoperative comorbidities, operative characteristics and postoperative complications were collected and compared using Chi-squared test, Wilcoxon-Mann-Whitney test and multivariate logistic regression analysis. RESULTS: Preoperative and postoperative risk factors for 30-day mortality following a hip/pelvis fracture were found: ASA classification, ascites, disseminated cancer, dyspnea, functional status, history of congestive heart failure (CHF), history of chronic obstructive pulmonary disease (COPD), a recent blood transfusion, and the postoperative complications: pneumonia, myocardial infarction, stroke, and septic shock. DISCUSSION: Several preoperative patient risk factors and postoperative complications greatly increased the odds for patient mortality following 30-days after initial surgery. Orthopaedic surgeons can utilize these predictive risk factors to better improve patient care. LEVEL OF EVIDENCE: Retrospective study. Level IV. SN - 1877-0568 UR - https://www.unboundmedicine.com/medline/citation/27496661/Predictors_of_30_day_mortality_following_hip/pelvis_fractures_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1877-0568(16)30079-2 DB - PRIME DP - Unbound Medicine ER -