PMID- 35865328
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230705
IS  - 0976-5662 (Print)
IS  - 2213-3445 (Electronic)
IS  - 0976-5662 (Linking)
VI  - 31
DP  - 2022 Aug
TI  - Comparative risk stratification for prediction of early postoperative morbidity 
      and mortality after open fixation of periarticular lower extremity fractures.
PG  - 101940
LID - 10.1016/j.jcot.2022.101940 [doi]
LID - 101940
AB  - INTRODUCTION: The identification of patients at higher risk of early 
      postoperative adverse events has implications for quality improvement, 
      preoperative medical optimization, and cost reduction through bundled payments. 
      The purpose of the present study was to develop points-based risk stratification 
      systems for predicting 30-day adverse events (AEs) and mortality after open 
      fixation of periarticular hip, knee, and ankle fractures. METHODS: Query of the 
      NSQIP database yielded 65,529 patients who underwent periarticular lower 
      extremity repair from 2010 to 2019. To generate our risk stratification systems, 
      60% of patients were randomly analyzed with multivariable regression plus 
      bootstrap modeling to identify independent risk factors for early AE or 
      mortality. A nomogram analysis was then conducted to assign scores for each risk 
      factor. To validate our models, the systems were tested for predictive ability 
      using the remaining 40% of patients. RESULTS: In total, 13,212 patients (20.2%) 
      experienced any AE and 3613 patients (5.5%) mortality within 30 days of fracture 
      fixation. Patients were assigned points for the following in both risk 
      stratification systems: fracture type, male gender, age, functional dependence, 
      anemia, pulmonary disease, congestive heart failure, and end-stage renal disease. 
      Corticosteroid use, hypertension, and insulin-dependent diabetes were additional 
      predictors for only AEs. The AE and mortality models had maximum scores of 27 and 
      17 points, and Harrell C statistics of 0.66 and 0.75, respectively. The estimated 
      risk of developing early AE ranged from 3.4 to 79.5% and mortality from 0.08 to 
      54.4%. CONCLUSION: Fracture type and preoperative characteristics can be used in 
      the prediction of early AE or mortality following open fixation of periarticular 
      lower extremity fractures, with a marked disparity in estimated risks depending 
      on the number of risk factors possessed by a patient. LEVEL OF EVIDENCE: 
      Therapeutic IV.
CI  - (c) 2022 Delhi Orthopedic Association. All rights reserved.
FAU - Xu, Amy L
AU  - Xu AL
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University School of 
      Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
FAU - Raad, Micheal
AU  - Raad M
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University School of 
      Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
FAU - Sotsky, Rachel B
AU  - Sotsky RB
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University School of 
      Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
FAU - Hughes, Alice J
AU  - Hughes AJ
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University School of 
      Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
FAU - Aiyer, Amiethab A
AU  - Aiyer AA
AD  - Department of Orthopaedic Surgery, The Johns Hopkins University School of 
      Medicine, 1800 Orleans Street, Baltimore, MD, 21287, USA.
LA  - eng
PT  - Journal Article
DEP - 20220704
PL  - India
TA  - J Clin Orthop Trauma
JT  - Journal of clinical orthopaedics and trauma
JID - 101559469
PMC - PMC9294326
OTO - NOTNLM
OT  - Ankle
OT  - Hip
OT  - Internal fixation
OT  - Knee
OT  - Lower extremity
OT  - NSQIP
OT  - Periarticular fracture
OT  - Risk stratification
EDAT- 2022/07/23 06:00
MHDA- 2022/07/23 06:01
PMCR- 2023/07/04
CRDT- 2022/07/22 02:24
PHST- 2022/04/10 00:00 [received]
PHST- 2022/07/01 00:00 [accepted]
PHST- 2022/07/22 02:24 [entrez]
PHST- 2022/07/23 06:00 [pubmed]
PHST- 2022/07/23 06:01 [medline]
PHST- 2023/07/04 00:00 [pmc-release]
AID - S0976-5662(22)00176-X [pii]
AID - 101940 [pii]
AID - 10.1016/j.jcot.2022.101940 [doi]
PST - epublish
SO  - J Clin Orthop Trauma. 2022 Jul 4;31:101940. doi: 10.1016/j.jcot.2022.101940. 
      eCollection 2022 Aug.