N. N. Branch1,2, A. Obirieze2, R. H. Wilson1,2 1Howard University College Of Medicine,Washington, DC, USA 2Howard University Hospital,Surgery,Washington, DC, USA
Introduction: Elderly patients 65 years and older represent an increasing proportion of the population, and they are typically more susceptible to open femoral fractures. However, factors such as bone quality, nutritional status and comorbidites may affect treatment approaches and outcomes. We aim to assess 30 day perioperative complications associated with open reduction and internal fixation of open femoral fractures in the elderly.
Methods: A retrospective analysis of the National Trauma Data Bank (NTDB) from 2007-2010 utilizing ICD-9 codes was conducted. Cases ≥ 18 years old, who underwent open reduction and internal fixation (ORIF) of the femur at a level I or level II trauma center were included. Patients were then stratified by age, with those 18-24 years serving as the reference group. Univariate, bivariate, and multivariate analyses were performed.
Results: 9,406 patients met the inclusion criteria, with the majority being white (61%), males (73%), between 25-44 years old (41%) with a mean age of 29 years. Patient with private insurance (25%) and injury via motor vehicle collisions (34%) were most common. Elderly patients comprised 9.5% of the total population of which 85% were White and 62% were female. Elderly patients were 85% more likely to have fixation after hospital day 2 (OR: 1.85 CI: 1.49-2.29 p<0.001), 94% more likely to have an organ/space surgical site infection (OR: 1.94 CI: 1.32-2.37 p=0.001), and more than seven times more likely to die (OR: 7.58 CI: 3.71-15.49 p<0.001). All patients were over three times more likely to die if they had at least one perioperative complication (OR: 3.6 CI: 2.48-5.24 p<0.001). All age groups were more likely to have at least one perioperative complication compared to those 18-24 years with the elderly having the greatest odds at 67% (OR: 1.67 CI: 1.25-2.21 p<0.001), followed by ages 45-64 (OR: 1.47 CI: 1.22-1.78 p<0.001), and ages 25-44 (OR: 1.30 CI: 1.10-1.55 p=0.002).
Conclusion: While the elderly represent a small proportion of open femoral fracture cases they are more likely to have a perioperative complication including infections. Moreover elderly patients are the group most likely to suffer the most profound complication of all; perioperative death as compared to their younger counterparts. While direct causality cannot be identified with this study, it is probable that a reduction of overall complications in this patient population could improve perioperative mortality.