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Orthopaedic fracture site and wound healing risk among end-stage renal disease patients undergoing open reduction
Gabriel Hanna1, Eric H Tischler2, Paul G Mastrokostas2
1Department of Orthopedic Surgery, Brookdale University Hospital, 1 Brookdale Plaza, NY, 11212, Brooklyn, USA.
Introduction:
The aims of this study are to 1) identify incidence rate of fracture occurrence among end-stage renal disease (ESRD) patients requiring open reduction internal fixation (ORIF) stratified by anatomic site and 2) assess the risk of perioperative wound complications among ESRD fracture patients requiring ORIF compared to non-ESRD patients.
Materials And Methods:
This retrospective cohort study utilized the Nationwide Inpatient Sample database, covering the period from January 2002 to December 2014, to examine patients over 18 years of age who underwent ORIF for extremity fractures in the United States. Two-sample Z-tests were employed to assess differences in patient demographics, comorbidities, and anatomical fracture sites between ESRD and non-ESRD cohorts. Additionally, multivariate logistic regression was used to examine differences in specific wound complications between these cohorts, and ANOVA tests assessed the effect of dialysis modality on wound complication risk.
Results:
A total of 867,378 patients undergoing ORIF, with 7055 (0.8 %) reported ESRD. ESRD patients had a significantly higher incidence of femur fractures compared to those without ESRD (61.9 % vs. 42.1 %, p < 0.05). Furthermore, ESRD patients had a 1.55, 2.14, and 2.57 times increased odds of wound complication (p = 0.001), wound dehiscence (p = 0.003), and non-healing wound (p = 0.007) compared to patients without ESRD, respectively. No significant differences were found in the impact of dialysis modality on overall wound complication, wound dehiscence, non-healing wounds, seroma, and wound infection rates (p > 0.05 for all).
Conclusions:
ESRD patients are predisposed to more frequent fractures, particularly of the femur, than those without ESRD. Furthermore, it underscores the increased incidence of perioperative wound complications, such as infections and delayed healing, in patients with ESRD undergoing ORIF.
