Length of stay and 30-day readmissions after isolated humeral shaft fracture open reduction and internal fixation compared to intramedullary nailing
| Autor: | Varun Arvind, Sara L Low, Emmanuel M. Illical, Robert K. Merrill, Colin M Whitaker |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Humeral Fractures Time Factors Databases Factual medicine.medical_treatment Patient Readmission law.invention Intramedullary rod 03 medical and health sciences 0302 clinical medicine law medicine Internal fixation Humans Humerus Risk factor Reduction (orthopedic surgery) General Environmental Science Aged Aged 80 and over 030222 orthopedics business.industry Incidence (epidemiology) 030208 emergency & critical care medicine Length of Stay Middle Aged medicine.disease Comorbidity United States Surgery Fracture Fixation Intramedullary Open Fracture Reduction medicine.anatomical_structure Logistic Models Treatment Outcome Heart failure Multivariate Analysis General Earth and Planetary Sciences Female business |
| Zdroj: | Injury. 51(4) |
| ISSN: | 1879-0267 |
| Popis: | Open reduction with internal fixation (ORIF) and intramedullary nailing (IMN) have similar union rates for treating humerus shaft fractures, but IMN leads to increased incidence of shoulder impingement and reoperation. The difference in 30-day readmission rate and length of stay (LOS) between these procedures is unknown. The objective of the study was to compare 30-day unplanned readmissions and length of stay between humeral shaft fractures fixed with either ORIF or IMN.The nationwide readmissions database (NRD) was queried for patients with humeral shaft fractures treated with ORIF or IMN between 2015-2016. IMN cases were propensity matched to ORIF cases based on demographic and co-morbid variables. Multivariable logistic regression determined if treatment modality was an independent risk factor for 30-day readmission or length of stay3 days.There were 406 patients treated with IMN matched to 406 patients treated with ORIF. The 30-day readmission rate was 6.4% for IMN and 4.9% for ORIF (p = 0.45), and the median LOS was 3 days for each group (p = 0.45). Congestive heart failure (CHF)(OR=2.7, p = 0.04), depression (OR=3.3, p = 0.0008), and electrolyte abnormality (OR=3.6, p = 0.0003) were independent risk factors for readmission. Older age (OR=1.02, p = 0.03), CHF (OR=2.4, p = 0.03), electrolyte abnormality (OR=2.6, p = 0.0001), obesity (OR=2.8, p0.0001), Medicaid (OR=2.1, p = 0.04), discharge to a facility (OR = 5.2, p0.0001), discharge with home health services (OR=2.4, p = 0.0003), and open fracture (OR=2.3, p = 0.01) were independent risk factors for LOS3 days. Procedure (ORIF vs. IMN) was not a predictor of 30-day readmission or LOS3 days.Comorbid conditions are risk factors for 30-day readmission and increased LOS. Comorbidity, discharge disposition, and open fractures are risk factors for increased LOS. Treating humeral shaft fractures with either ORIF or IMN did not affect readmission or length of stay. |
| Databáze: | OpenAIRE |
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