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J Wrist Surg
DOI: 10.1055/a-2710-9372
Scientific Article

Impact of Patient Demographics, Surgeon Volume, and Hospital Type on Distal Radius Fracture Surgery Outcomes: A Population-Based Study

Authors

  • Jonathan Persitz 

    1   Division of Plastic, Reconstructive and Aesthetic Surgery, Hand Program, University Health Network, Toronto Western Hospital, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2   Division of Orthopaedic Surgery, Department of Surgery Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Heather Baltzer

    1   Division of Plastic, Reconstructive and Aesthetic Surgery, Hand Program, University Health Network, Toronto Western Hospital, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Andrew Calzavara

    3   Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada

  • Jesse Wolfstadt

    4   Division of Orthopaedics, Sinai Health System, Department of Surgery Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Ryan Paul

    1   Division of Plastic, Reconstructive and Aesthetic Surgery, Hand Program, University Health Network, Toronto Western Hospital, Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
    2   Division of Orthopaedic Surgery, Department of Surgery Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Andrea Chan

    2   Division of Orthopaedic Surgery, Department of Surgery Affiliated with Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

  • Samantha Lee

    3   Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada

  • Brandon Zagorski

    3   Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada

  • David R. Urbach

    3   Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
    5   Department of Surgery Affiliated with Temerty Faculty of Medicine, University of Toronto, Women's College Hospital, Toronto, Ontario, Canada

Funding Information This project was funded by the Canadian Institutes of Health Research through a project grant (number PJT-166108).
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Abstract

Purpose

This study aimed to evaluate the impact of patient demographics, surgeon volume, and hospital type on composite outcomes, infection, and revision following surgery for acute, isolated distal radius fractures (DRFs).

Materials and Methods

This population-based study examined Ontario administrative health data from 2010 to 2020, identifying 13,389 adults who underwent surgical fixation for acute, isolated DRFs. Patients with open fractures, other associated injuries, neurovascular injuries, prior surgery on the same limb, or any other factors that could worsen prognosis were excluded. Covariates included were time to surgery, patient demographics (age, biological sex, comorbidities, rural residence, income quintile), surgeon factors (volume, fixation type), fracture type (intra-articular vs. extra-articular), and hospital type (teaching vs. non-teaching). The primary outcome was a composite measure of complications, including infection, revision surgery, and hardware removal. Secondary outcomes included postoperative infection and revision procedures. Time-to-event Cox proportional multivariable models were applied to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), adjusting for covariates.

Results

A total of 13,389 patients were included in the analysis. Higher surgeon volume was associated with improved outcomes: Every additional five DRF surgeries performed in the prior year reduced the risk of composite complications by 4% (HR 0.96, 95% CI 0.94–0.98; p < 0.001) and the risk of revision surgery by 10% (HR 0.90, 95% CI 0.86–0.93; p < 0.001).

Rural residence was associated with a 44% higher risk of postoperative infection (HR 1.43, 95% CI 1.08–1.89; p = 0.01). Increased comorbidity burden, measured by the Johns Hopkins score, was consistently associated with worse outcomes: Each one-point increase corresponded to a 6.4% higher likelihood of composite complications (HR 1.06, 95% CI 1.05–1.08; p < 0.001).

Female sex was protective across outcomes, reducing the risk of infection by 25% (HR 0.75, 95% CI 0.59–0.96; p = 0.02) and revision surgery by 19% (HR 0.81, 95% CI 0.68–0.98; p = 0.02). Older age was associated with a modest but consistent protective effect, reducing the risk of composite complications by 1% per year of age (HR 0.99, 95% CI 0.98–0.99; p < 0.001).

Conclusion

Surgeon volume independently reduced complications and revisions after DRF surgery, while rural residence and higher comorbidity burden markedly increased infection risk. The protective effects of female sex and older age highlight the importance of nuanced risk assessment. Strategies to expand access to high-volume surgeons and targeted perioperative care may improve outcomes and reduce disparities in fracture management.

Level of Evidence

Level III.

Keywords

radius - surgery - outcomes - complications

Ethical Approval

This project falls under Section 45 of the Personal Health Information Protection Act (PHIPA) and ICES and is overseen by the Sunnybrook Health Sciences Centre Research Ethics Board.


Supplementary Material



Publication History

Received: 29 June 2025

Accepted: 25 September 2025

Article published online:
10 October 2025

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