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Delay of fixation increases 30-day complications and mortality in traumatic pelvic ring injuries

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

While decreased time to fixation in femur fractures improves mortality, it remains unclear if the same relationship exists for pelvic fractures. The National Trauma Data Bank (NTDB) is a data repository for trauma hospitals in the United States (injury characteristics, perioperative data, procedures, 30-day complications), and we used this to investigate early, significant complications after pelvic-ring injuries.

Methods

The NTDB (2015–2016) was queried to capture operative pelvic ring injuries in adult patients with injury severity score (ISS) ≥ 15. Complications included medical and surgical complications, as well as 30-day mortality. Multivariable logistic regression was used to investigate the association between days to procedure and complications after adjusting for demographic characteristics and comorbidities.

Results

2325 patients met inclusion criteria. 532 (23.0%) sustained complications, and 72 (3.2%) died within the first 30 days. The most common complications were deep vein thrombosis (DVT) (5.7%), acute kidney injury (AKI) (4.6%), and unplanned intensive care unit (ICU) admission (4.4%). In a multivariate analysis, days to procedure was independently significantly associated with complications, with an adjusted odds ratio (95% confidence interval) of 1.06 (1.03–1.09, P < 0.001), best interpreted as a 6% increase in the odds of complication or death for each additional day.

Conclusion

Time to pelvic fixation is a significant and modifiable risk factor for major complications and death. This suggests we should prioritize time to pelvic fixation on trauma patients to minimize mortality and major complications.

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Funding

The authors received no funding for the submitted work. Dr. Working serves in a volunteer manner as a section editor at the Journal of Orthopaedic Trauma.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR, USA

    Michelle M. Lawson, Danielle F. Peterson, Darin M. Friess & Zachary M. Working

  2. Department of Surgery, Oregon Health & Science University, Portland, OR, USA

    Mackenzie R. Cook

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  1. Michelle M. Lawson
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Correspondence to Zachary M. Working.

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The enclosed work was performed in compliance with modern ethical standards of publishing. The work was performed unfunded. The authors received no funding for the submitted work. [Corresponding/senior author] serves in a volunteer manner as a section editor at the Journal of Orthopaedic Trauma. The authors report no further conflicts of interest relevant to this work. The enclosed research was performed after ethical approval was obtained from the local institutions IRB.

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Lawson, M.M., Peterson, D.F., Friess, D.M. et al. Delay of fixation increases 30-day complications and mortality in traumatic pelvic ring injuries. Eur J Orthop Surg Traumatol (2023). https://doi.org/10.1007/s00590-023-03589-9

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