Predictors of Delayed Surgery After Distal Radius Fracture: A Large National Database Study

Surgical timing after distal radius fracture may impact patient outcome. This retrospective study assessed the timing of surgery after distal radius fracture and predictors of delayed surgery.

Patients who had distal radius fractures were identified from the PearlDiver M161Ortho dataset. Those who went on to have surgery in the subsequent 52 weeks were identified, with immediate surgery designated as occurring in weeks 0 to 2 after fracture and delayed surgery designated as occurring in weeks 3 to 52 after fracture. Demographics of patients with immediate and delayed surgery, including age, sex, comorbidity burden (measured by Elixhauser Comorbidity Index [ECI]), region of the country where surgery was performed, insurance (commercial, Medicare, Medicaid), and smoking status (non-smoker, cannabis, tobacco, both), were assessed and compared by multivariate analyses.

A total of 90,570 patients undergoing surgery for distal radius fractures were identified, of whom immediate surgery was performed for 76,683 (88.0%) and delayed surgery was performed for 10,887 (12.0%). Independent predictors of delayed surgery included non-clinical factors (Medicaid [vs commercial insurance]: odds ratio [OR], 1.62, P<.0001; and region [vs Midwest]: West, OR, 1.39, P<.0001; Northeast, OR, 1.37, P=.0115; and South, OR, 1.21, P=.0001) as well as clinical factors (smoking tobacco [vs non-smoker]: OR, 1.31, P<.0001; and increased ECI: OR, 1.14 per 2-point increase, P<.0001).

In a large cohort of patients, 12% of distal radius fracture surgeries occurred outside the 2-week window. These cases were predicted by non-clinical and clinical factors that deserve attention to limit the delay of such surgeries. [Orthopedics. 2025;48(2):e75-e80.].