Is the "Fix-and-Replace" Method Associated With Higher Early Perioperative Risk Than Isolated Internal Fixation for...

Area of Science:

• Orthopedic Surgery
• Geriatric Medicine
• Trauma Surgery

Background:

• Acetabular fractures are complex injuries often requiring surgical intervention in older adults.
• Frailty is a growing concern in geriatric populations and may impact surgical outcomes.
• Understanding frailty's role is crucial for optimizing treatment strategies for acetabular fractures.

Purpose of the Study:

• To investigate the impact of preoperative frailty on 30-day outcomes following surgical treatment of acetabular fractures.
• To compare outcomes between open reduction internal fixation (ORIF) alone versus ORIF with total hip arthroplasty (THA) in frail patients.

Main Methods:

• Retrospective cohort study utilizing the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2015-2020).
• Included patients aged 60+ undergoing ORIF +/- THA for OTA/AO type 62 A-C fractures.
• Frailty assessed using the revised Risk Analysis Index and 5-Item Modified Frailty Index (mFI-5). Outcomes included complications, mortality, readmission, length of stay, and discharge disposition.

Main Results:

• Frail patients (65.5%) had higher complication (OR: 3.31) and mortality (3.7%) rates.
• ORIF+THA was associated with increased transfusion (OR: 2.70) but decreased length of stay >3 days (OR: 0.41) and non-home discharge (OR: 0.52) compared to ORIF.
• Pre-frail and frail patients undergoing ORIF+THA had better odds of favorable outcomes (OR: 9.69).

Conclusions:

• Surgical treatment of acetabular fractures carries a 12-19% 30-day complication risk for frail patients.
• Frailty is a significant predictor of early morbidity, comparable to age.
• ORIF+THA may offer improved outcomes regarding length of stay and discharge disposition for frail patients with acetabular fractures.