Delayed surgical fixation is associated with increased mortality in patients with distal femur fractures

To address the conflicting evidence in the literature regarding time to surgery and its impact on outcomes for distal femoral fractures.

This is a retrospective review of the American College of Surgeon's (ACS) National Surgical Quality Improvement Project (NSQIP®) database, that collects data from 680 hospitals across the United States. The database was queried from 2010-2021. Case selection was done by use of ICD-9 & ICD-10 codes for native distal femoral fractures and periprosthetic distal femur fractures, along with CPT codes for surgical fixation of distal femur, total knee arthroplasty and revision knee arthroplasty. Pre-operative, operative and post-operative factors were compared for patients undergoing surgery on hospital day 0 or 1 (HD ≤ 1) to patients undergoing surgery after hospital day 1(HD > 1). Primary outcome measure was 30-day mortality. Chi-square and logistic regression were used for univariable and multivariable analyses, respectively.

A total of 6857 cases were identified (mean age of 71.5 years). 84.5 % underwent surgery on HD ≤ 1, and 15.5 % on HD > 1. Rate of mortality was 1.37 % and 3.26 %, respectively. Patients who underwent surgical fixation of distal femoral fracture on HD ≤ 1 had a 40 % decrease in odds of mortality compared to fixation on HD > 1 (OR 0.587; p = 0.031). A multi variable analysis revealed that presence of dyspnea (OR 4.338, p = 0.005), preoperative blood transfusion (HR 2.32, p = 0.001) and bleeding disorder (OR 1.727, p = 0.03) were associated with increased mortality at 30-days on multivariable analysis, while younger age (OR 0.216; p = 0.001) had a protective effect.

Delayed surgical fixation is associated with increased odds of 30-day mortality for patients with distal femoral fractures. Further studies will help determine if the increased mortality is caused by the delay itself or by other confounding variables not identified in this study that may be associated with the reason for the delay.

Level III.