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Do orthopaedic trauma patients develop higher rates of cardiac complications? An analysis of 56,000 patients

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Less than 5 % of orthopaedic patients develop postoperative cardiac complications; however, there are little data suggesting which orthopaedic patients are at greatest risk. In an era where emerging reimbursement models place an emphasis on quality, reducing complications through perioperative planning will be of paramount importance for orthopaedic surgeons. The purpose of this study was to determine whether orthopaedic trauma patients are at greater risk for postoperative cardiac complications and to reveal which factors are most predictive of these complications.

Methods

All orthopaedic patients were identified in the 2006–2013 ACS-NSQIP database. Cardiac complications were defined as cardiac arrests or myocardial infarctions within 30 days following surgery. Chi squared analysis determined differences in cardiac complication rates between trauma and non-trauma patients. Bivariate analysis incorporating over 40 patient/surgical characteristics determined significant associations between patient characteristics and cardiac complications. These factors were incorporated into a multivariate regression model to identify predictive risk factors for cardiac complications.

Results

The presence of a traumatic injury resulted in greater odds of developing cardiac complications (OR: 1.645, p < 0.001). The cardiac complication rate in the trauma group was 1.3 % compared to 0.3 % in the non-trauma group (p < 0.001). For trauma patients, ventilator use (OR: 27.354, p = 0.004), recent transfusion (OR: 19.780, p = 0.001), and history of coma (OR: 17.922, p = 0.020) were most predictive of cardiac complications.

Conclusion

Orthopaedic trauma patients are more likely to develop cardiac complications than non-trauma patients. To reduce cardiac complications, orthopaedic traumatologists should be aware of patient risk factors including ventilator use, blood transfusion, and history of coma.

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Author information

Authors and Affiliations

  1. The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA

    A. C. Dodd, N. Lakomkin, V. Sathiyakumar, W. T. Obremskey & M. K. Sethi

Authors
  1. A. C. Dodd
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  2. N. Lakomkin
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  3. V. Sathiyakumar
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  4. W. T. Obremskey
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  5. M. K. Sethi
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Corresponding author

Correspondence to M. K. Sethi.

Ethics declarations

This study was performed in accordance with the relevant regulations of the US Health Insurance Portability and Accountability Act (HIPAA) and the ethical standards of the 1964 Declaration of Helsinki. The protocol was approved by the Vanderbilt Institutional Review Board.

Conflict of interest

Author William T. Obremskey (WTO) has done expert testimony in legal matters. The institution of one or more authors (WTO) has received a grant from the Department of Defense. Ashley C. Dodd, Nikita Lakomkin, Vasanth Sathiyakumar, and Manish K. Sethi declare they have no conflict of interest.

Appendix: Description of trauma CPT codes

Appendix: Description of trauma CPT codes

Upper extremity

CPT code

Description

23515

Open treatment of clavicular fracture

23585

Open reduction internal fixation of scapular fracture

23615

Open treatment of proximal humeral fracture

23616

Proximal humerus replacement (total shoulder arthroplasty or hemi-arthropasty)

23630

Open treatment of greater tuberosity fracture with or without internal fixation

24515

Open treatment of humeral shaft fracture

24516

Intramedullary nailing of humerus fracture

24538

Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture

24545

Open treatment of supracondylar humerus fracture

24546

Open treatment of supracondylar humerus fracture with intracondylar split

24566

Percutaneous treatment of humeral epicondylar fracture, medial or lateral, with manipulation

24575

Open treatment of humeral epicondyle fracture

24579

Open treatment of humeral condyle fracture

24586

Treatment of periarticular fracture of dislocation of open elbow

24587

Treatment of periarticular fracture of dislocation of open elbow with implant arthroplasty

24615

Open treatment elbow dislocation

24635

Open treatment of Monteggia fracture

24665

Open reduction internal fixation of radial head or neck

24666

Replacement of radial head or neck

24685

Open treatment of olecranon process

24800

Arthrodesis of elbow joint with or without local autograft/allograft

24900

Amputation through humerus

24930

Revision of trans-humeral amputation

25515

Open treatment of radial shaft fracture

25525

Open treatment of radial shaft fracture and closed treatment of radioulnar dislocation

25526

Open treatment of radial shaft fracture and open treatment of radioulnar dislocation

25545

Open treatment of ulnar shaft fracture

25574

Open treatment radial and ulnar shaft fractures (radial or ulna)

25575

Open treatment of radial and ulnar shaft fractures (radial and ulna)

25607

Open treatment of extra-articular distal radial fracture

25608

Open treatment of intra-articular distal radial fracture

25609

Open treatment of distal radial fracture with >3 fragments

25611

Percutaneous skeletal fixation with or without external fixation of distal radius

25620

Open treatment with or without internal or external fixation of distal radius

25628

Open treatment of carpal scaphoid navicular fracture

25920

Disarticulation of wrist

Hip and pelvis

CPT code

Description

27125

Hip hemiarthroplasty

27187

Prophylactic treatment of femoral neck and proximal femur

27215

Open treatment of iliac wing fracture with internal fixation

27217

Treatment of anterior ring fracture with internal fixation

27218

Treatment of posterior ring fracture with internal fixation

27226

Treatment of anterior or posterior wall acetabular fracture

27227

Treatment of anterior or posterior column (or transverse) acetabular fracture

27228

Treatment of acetabulum and posterior column, transverse, or single column with wall fracture

27235

Percutaneous skeletal fixation of proximal femoral fracture (neck)

27236

Open treatment of femoral fracture (neck)

27244

Open reduction internal fixation of interochanteric, peritrochanteric, or subtrochanteric femoral fracture

27245

Intramedullary nailing of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture

27248

Open treatment of greater trochanteric fracture with internal fixation

27253

Treatment of open traumatic hip dislocation

27254

Open treatment of acetabular wall or femoral head fracture with hip dislocation

27256

Treatment of spontaneous hip dislocation by abduction, splint, or traction

27258

Open treatment of spontaneous hip dislocation with replacement of femoral head in acetabulum

27259

Open treatment of spontaneous hip dislocation with replacement of femoral head in acetabulum and femoral shaft shortening

27269

Open treatment of femoral head fracture with internal fixation

Lower extremity

CPT code

Description

27506

Intramedullary nailing of open femoral shaft fracture

27507

Open reduction internal fixation of femoral shaft fracture

27509

Percutaneous skeletal fixation of distal femoral fracture

27511

Open treatment of femoral supracondylar without intercondylar extension fracture

27513

Open treatment of femoral supracondylar with intercondylar extension fracture

27514

Open treatment of distal femoral fracture

27519

Open treatment of distal femoral epiphyseal separation

27535

Open internal or external fixation of unicondylar tibial plateau

27536

Open internal or external fixation of bicondylar tibial plateau

27590

Above knee amputation

27591

Above knee amputation, first cast

27592

Above knee amputation, open/circular (guillotine)

27756

Percutaneous skeletal fixation of tibial shaft fracture

27758

Open reduction internal fixation of tibial shaft fracture

27759

Intramedullary nailing of tibial shaft fracture

27766

Open treatment of medial malleolus fracture

27769

Open treatment of posterior malleolus fracture

27784

Open treatment of proximal fibial fracture

27792

Open treatment of distal fibial fracture

27814

Open treatment of bimalleolar ankle fracture

27822

Open treatment of trimal fracture (medial and/or lateral without posterior)

27823

Open treatment of trimal fracture (open medial and/or lateral with posterior lip)

27826

Open treatment distal weight-bearing articular surface of fibula

27827

Open treatment of tibial pilon/plafond fracture of tibia only

27828

Open treatment of tibial pilon/plafond with fibular fracture

27880

Below knee amputation

27881

Below knee amputation with first cast

27882

Below knee amputation, open/circular (guillotine)

27888

Amputation of ankle through malleoli

27889

Ankle disarticulation

28420

Open treatment of calcaneus fracture (with autograft)

28445

Open treatment of talus fracture

28800

Amputation of foot, midtarsal

28805

Amputation of foot, transmetatarsal

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Dodd, A.C., Lakomkin, N., Sathiyakumar, V. et al. Do orthopaedic trauma patients develop higher rates of cardiac complications? An analysis of 56,000 patients. Eur J Trauma Emerg Surg 43, 329–336 (2017). https://doi.org/10.1007/s00068-016-0649-6

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  • DOI: https://doi.org/10.1007/s00068-016-0649-6

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