Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF for Ankle Fractures

Category: Ankle, Trauma Introduction/Purpose: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >=80 years). Past literature has shown octogenarians to be a potentially vulnerable population that have drastically different adverse outcomes and higher resource utilization as compared to individuals below the age of 80 years. Methods: The 2012-2017 American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) was queried using Current Procedural Terminology codes for patients undergoing open reduction internal fixation (ORIF) for isolated uni-malleolar (CPT-27766, CPT-27769, CPT-27792), bi-malleolar (CPT-27814) and tri-malleolar (CPT-27822, CPT-27823) ankle fractures. The study cohort was divided into three distinct groups for comparisons (Age <65 years, Age 65-79 years and Age=>80 years/octogenarians + nonagenarians). Multi-variate regression analyses were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for differences in baseline clinical characteristics (age, gender, sex, race, fracture type/severity, open vs. closed fracture, admission status, BMI, co-morbidities, functional health status, ASA group and operative time). For comparison purposes, Age<65 years was taken as reference group in multi-variate regression models. Results: A total of 19,585 patients were included – out of which 1,033 (5.3%) were octogenarians/nonagenarians (=>80 years). Following multivariate analysis, individuals aged =>80 years were at a significantly higher risk of 30-day wound complications (OR 1.84; p=0.019), pulmonary complications (OR 3.88; p<0.001), renal complications (OR 1.96; p=0.015), septic complications (OR 3.72; p=0.002), urinary tract infections (OR 2.24; p<0.001), bleeding requiring transfusion (OR 1.90; p=0.025), mortality (OR 7.44; p<0.001), readmissions (OR 1.65; p=0.004) and non-home discharge (OR 13.91; p<0.001). Individuals between the age of 65-79 years only had a higher risk of pulmonary complications (OR 2.30; p=0.004), urinary tract infections (OR 2.24; p<0.001), readmissions (OR 1.41; p=0.005) and non-home discharges (OR 3.55; p<0.001), with the effect sizes being small as compared to age >=80 years group. Conclusion: Based on the findings, it appears that octagenarians and nonagenarians (age =>80) are a fundamentally distinct and vulnerable age group that is at a higher risk of complications, readmissions, mortality and non-home discharges as compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Providers should understand the importance of pre-operative counselling and risk-stratification in this vulnerable patient population.

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Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211011462 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110114

Author(s):

Mitchell T. Gray ◽

Krystin A. Hidden ◽

Azeem T. Malik ◽

Safdar N. Khan ◽

Laura Phieffer ◽

...

Keyword(s):

High Risk ◽

Age Groups ◽

Ankle Fractures ◽

Independent Effect ◽

Wound Complications ◽

High Risk Population ◽

Septic Complications ◽

Operative Outcomes ◽

Co Morbidity ◽

Tract Infections

Introduction: Despite an increasing number of elderly individuals undergoing surgical fixation for ankle fractures, few studies have investigated peri-operative outcomes and safety of surgery in an octogenarian and nonagenarian population (age >80 years). Materials and Methods: The 2012-2017 American College of Surgeons database was queried for patients undergoing open reduction internal fixation for isolated uni-malleolar, bi-malleolar and tri-malleolar ankle fractures. The study cohort was divided into 3 comparison groups (age <65 years, 65-75 and >80). Multi-variate regression analyzes were used to compare the independent effect of varying age groups on 30-day post-operative outcomes while controlling for baseline clinical characteristics and co-morbidity burdens. Results: A total of 19,585 patients were included: 5.3% were >80 years, 18.1% were 65-79 years, and 76.6% were <65 years. When compared to the non-geriatric population, individuals >80 years were at a significantly Abstract: higher risk of 30-day wound complications (OR 1.84; p = 0.019), pulmonary complications (OR 3.88; p < 0.001), renal complications (OR 1.96; p = 0.015), septic complications (OR 3.72; p = 0.002), urinary tract infections (OR 2.24; p < 0.001), bleeding requiring transfusion (OR 1.90; p = 0.025), mortality (or 7.44; p < 0.001), readmissions (OR 1.65; p = 0.004) and non-home discharge (OR 13.91; p < 0.001). Discussion: Octogenarians undergoing ankle fracture fixation are a high-risk population in need of significant pre-operative surgical and medical optimization. With the majority of patients undergoing non-elective ORIF procedures, it is critical to anticipate potential complications and incorporate experienced geriatric providers early in the surgical management of these patients. Conclusions: Octogenarians and nonagenarians are fundamentally distinct and vulnerable age groups with a high risk of complications, readmissions, mortality and non-home discharges compared to other geriatric (65-79 years) and non-geriatric (<65 years) patients. Pre-operative counseling and risk-stratification are essential in this vulnerable patient population.

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Purulent-septic complications in patient with renal calyx diverticulum

Urologicheskie vedomosti ◽

10.17816/uroved55486 ◽

2021 ◽

Vol 11 (1) ◽

pp. 87-92

Author(s):

Sergey A. Zamyatnin ◽

Irina S. Gonchar ◽

Andrey V. Tsygankov

Keyword(s):

Urinary Tract ◽

Surgical Treatment ◽

Urinary Tract Infections ◽

Rare Case ◽

Left Kidney ◽

Clinical Manifestations ◽

Septic Complications ◽

Middle Group ◽

Associated Diseases ◽

Tract Infections

The calyx diverticulum is a cavity lined with urothelium that communicates through a narrow canal with the renal calyx-pelvis system. Most calyx diverticula are 0.5 to 2.0 cm in diameter and require surgical treatment exclusively for clinical manifestations of associated diseases. The most common complications of this nosology include urolithiasis and recurrent urinary tract infections. This article presents a rare case of a large diverticulum of the middle group of the calyces of the left kidney. The dimensions of the cavity filled with urine were 10 cm, which resulted in recurrent pyelonephritis, paranephritis and urosepsis.

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Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty

Advances in Orthopedics ◽

10.1155/2016/7268985 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 15

Author(s):

Andrew P. Alvarez ◽

Alysen L. Demzik ◽

Hasham M. Alvi ◽

Kevin D. Hardt ◽

David W. Manning

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Improvement Program ◽

Steroid Use ◽

Female Sex ◽

Tract Infections

Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients.Methods.We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon’s National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI.Results.1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6–2.7), chronic steroid use (OR 2.0, 95% CI 1.2–3.2), ages 60–69 (OR 1.5, 95% CI 1.0–2.1), 70–79 (OR 2.0, 95% CI 1.4–2.9), and ≥80 (OR 2.3, 95% CI 1.5–3.6), ASA Classes 3–5 (OR 1.5, 95% CI 1.2–1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3–2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3–2.4).Conclusions.In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement.

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