Prolonged Operative Time Associated with Increased Healthcare Utilization after Open Reduction and Internal Fixation of Intra-Articular and Extra-Articular Distal Radial Fractures: An Analysis of 17,482 Cases

Abstract

Background The current literature does not contain a quantitative description of the associations between operative time and adverse outcomes after open reduction and internal fixation (ORIF) of distal radial fractures (DRF).

Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative health care utilization and 2) the incidence of local wound complications.

Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for DRF ORIF cases (January 2012–December 2018). A total of 17,482 cases were identified. Primary outcomes included health care utilization (length of stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time category. Secondary outcome was incidence of wound complications per operative-time category. Multivariate regression was conducted to determine operative-time categories associated with increased risk while adjusting for demographics, comorbidities, and fracture type. Spline regression models were constructed to visualize associations.

Results The 121 to 140-minute category was associated with significantly higher risk of a LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1–2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09–2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33–3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05–3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59–7.79; p = 0.002). There was no association between operative time and 30-day readmission (p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute category (OR: 3.02; 95% CI: 1.08–8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57–36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes if operative times were 50 minutes or less.

Conclusion Our findings demonstrate that prolonged operative time is correlated with increased odds of health care utilization and wound complications after DRF ORIF. Operative times greater than 60 minutes seem to carry higher odds of postoperative complications.

Keywords

distal radial fractures (DRF) - complications - operative time - readmission - reoperation - local complications

Ethical Approval

The present study utilized a publicly available database; therefore, we did not require institutional review board approval.

Authors' Contributions

J.P.S. contributed in the initial draft writing, conceptualization, and critical draft revisions; E.O. in supervision, conceptualization, critical draft revisions, and data collection; A.K.E. in initial draft writing, statistical analysis, and critical draft revisions. D.G. in statistical analysis, conceptualization, and critical draft revisions; K.M. in initial drafting, critical draft revision, and data collection; M.N. in data collection, statistical analysis, supervision, and conceptualization; and J.F.S. in supervision, critical draft revisions, and methodological evaluation.

Publication History

Received: 19 July 2021

Accepted: 10 September 2021

Article published online:
26 October 2021

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