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Analysis of Incidence and Outcome Predictors for Patients Admitted to US Hospitals with Acetabular Fractures from 1990 to 2010

September 27, 2018 | Surgery
Matthew J. Best, MD ; Leonard T. Buller, MD ; Stephen M. Quinnan, MD
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr. Best is a Resident Physician, Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland. Dr. Buller is a Clinical fellow, Adult Reconstruction and Joint Replacement Division, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. Dr. Quinnan is Assistant Professor of Clinical Orthopaedics, Trauma Surgery, University of Miami/Jackson Memorial Hospital, Miami, Florida.

Address correspondence to: Leonard T. Buller, MD, Hospital for Special Surgery, 535 East 70th street, New York, NY 10021 (tel, 216-780-6534; email, bullerl@hss.edu).

Matthew J. Best, MD Leonard T. Buller, MD Stephen M. Quinnan, MD . Analysis of Incidence and Outcome Predictors for Patients Admitted to US Hospitals with Acetabular Fractures from 1990 to 2010. Am J Orthop.

September 27, 2018

TAKE-HOME POINTS

  • The population-adjusted incidence of acetabular fractures increased between 1990 and 2010. Mortality associated with acetabular fractures decreased from 5.9% to 0.4% between 1990 and 2010.
  • The proportion of patients treated with ORIF increased from 12.6% to 20.4% between 1990 and 2010.
  • The average in-patient hospital length of stay following acetabular fracture decreased from 17.0 to 10.4 days between 1990 and 2010.
  • ORIF is associated with the lowest odds of mortality following acetabular fracture.

Interestingly, male gender and younger age were associated with operative management of the acetabular fracture. In contrast, there was a decreased likelihood of operative treatment among elderly patients and those patients with cardiac comorbidities. It is possible that the relationship we found between the likelihood of ORIF and age relates to the bimodal distribution of fractures, with higher energy and potentially more displaced fractures occurring in younger patients3-5 and lower energy fractures in the elderly.

In contrast to decreasing in-hospital days of care, there was a rise in the number of adverse events between 1990 (10.9%) and 2010 (37.6%). This can be partially attributed to the increased rates of blood transfusion, which was received by 9.5% of patients with acetabular fractures in the final study year. Additionally, surgical intervention was associated with increased adverse events in this study, and surgical intervention increased over the study period. Other factors that may have contributed to an increase in adverse events include an aging population,52 as advanced age was independently associated with higher odds of adverse events in this study.

Despite the strengths of using large, national databases for epidemiological research,53 this study has several limitations. Like all large databases, the NHDS is subject to error in coding and data entry.54 Additionally, the database only allows for 7 diagnostic codes and 4 procedure codes per entry. As a result, the prevalence of comorbid conditions and adverse events may be underreported.25 Moreover, the severity of a comorbid disease cannot be appreciated when dichotomously classified.55 Another limitation is that the database only provides inpatient data, so complications that arise after discharge, as well as follow-up data, are unknown. Furthermore, the results of this study are limited to practice patterns in the US from 1990 to 2010. This database does not provide injury mechanisms, so we cannot distinguish between high-energy and low-energy injuries. Lastly, analysis of the different types of acetabular fractures was not performed since classification of acetabular fractures cannot be assessed with ICD-9 codes.

CONCLUSION

This study is the largest epidemiologic analysis of acetabular fractures in the US and also provides predictors of in-hospital mortality. The incidence of acetabular fractures in the US is increasing, while mortality is decreasing. Identifying risk factors associated with poor outcomes has the potential to change treatment strategies, resource allocation, in-hospital monitoring, and discharge planning for this patient population.

This paper will be judged for the Resident Writer’s Award.

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