The impact of age at surgery on short-term outcomes and readmissions following open reduction internal fixation for distal radius fractures

Background

Increasing patient age at the time of surgery has been associated with adverse outcomes following hand surgeries. However, heterogeneous management data exists for operative versus nonoperative management of distal radius fractures (DRFs) in the elderly. Thus, it is imperative to characterize the impact patient age has on short-term outcomes following open reduction and internal fixation (ORIF) for DRFs.

Methods

Patients who underwent ORIF for DRFs were identified using the National Readmissions Database. Patients were stratified into cohorts based on age at surgery, including: 18–49, 50–59, 60–69, 70–79, and 80+ years old; further sub-analysis of patients <65 and ≥ 65 years old was also conducted. Demographic, complication, readmission, total cost, and length of stay (LOS) information was compared.

Results

12,766, 5,113, 5,639, 4,901, and 4260 patients were identified in the 18–49, 50–59, 60–69, 70–79, and 80+ years old cohorts, respectively; 20,674 patients were <65 years old and 12,005 were ≥65 years old were. Older patients had higher rates of both 30-day (OR: 1.19, p < 0.01) and 90-day readmissions (OR: 1.31; p < 0.01). Comparing age <65 vs. ≥65 years, the 30- and 90-day readmissions were 5.2 % vs. 7.0 % and 8.6 % and 13.3 %, respectively. Younger age was an independent predictor of infection complications (OR: 0.55; p = 0.029) and median nerve injury (OR: 0.77; p < 0.01) after ORIF, with ≥65 years of age as the independent variable. There was a stepwise decrease in overall costs with increasing age (p < 0.01) and those older than 65 years stayed in the hospital on average 2.0 days shorter than their younger counterparts (p < 0.01).

Conclusion

Increasing age was associated with increased readmission, but decreased infections, nerve injury, LOS, and related total charges after ORIF for DRF. This study should be utilized in conjunction with clinical outcomes literature to appropriately counsel patients as to the complications and expected outcomes related to fixation of DRFs.