Article

Analysis of Incidence and Outcome Predictors for Patients Admitted to US Hospitals with Acetabular Fractures from 1990 to 2010

Publish date: September 27, 2018

References

1. Laird A, Keating JF. Acetabular fractures: a 16-year prospective epidemiological study. J Bone Joint Surg Br. 2005;87(7):969-973. doi:10.1302/0301-620X.87B7.16017.

2. Geoghegan JM, Longdon EJ, Hassan K, Calthorpe D. Acetabular fractures in the UK. What are the numbers? Injury. 2007;38(3):329-333. doi:10.1016/j.injury.2006.09.015.

3. Tavakoli Darestani R, Kazemian G, Emami Moghaddam M, Manafi Rasi A, Alipour Y, Bagherian Lemraski MM. An unusual combination of acetabular and pelvic fracture: is this a new subtype of acetabular fracture? Trauma Mon. 2013;18(1):37-40. doi:10.5812/traumamon.9613.

4. McDonnell M, Schachter AK, Phillips DP, Liporace FA. Acetabular fracture through the triradiate cartilage after low-energy trauma. J Orthop Trauma. 2007;21(7):495-498. doi:10.1097/BOT.0b013e31812f67ff.

5. Giannoudis PV, Grotz MR, Tzioupis C, et al. Prevalence of pelvic fractures, associated injuries, and mortality: the United Kingdom perspective. J Trauma. 2007;63(4):875-883. doi:10.1097/01.ta.0000242259.67486.15.

6. Gänsslen A, Pohlemann T, Paul C, Lobenhoffer P, Tscherne H. Epidemiology of pelvic ring injuries. Injury. 1996;27 Suppl 1:S-A13-A20. doi:10.1016/S0020-1383(96)90106-0.

7. Matta JM. Fractures of the acetabulum: accuracy of reduction and clinical results in patients managed operatively within three weeks after the injury. J Bone Joint Surg Am. 1996;78(11):1632-1645. doi:10.2106/00004623-199611000-00002.

8. Wright R, Barrett K, Christie MJ, Johnson KD. Acetabular fractures: long-term follow-up of open reduction and internal fixation. J Orthop Trauma. 1994;8(5):397-403. doi:10.1097/00005131-199410000-00005.

9. Giannoudis PV, Grotz MR, Papakostidis C, Dinopoulos H. Operative treatment of displaced fractures of the acetabulum. A meta-analysis. J Bone Joint Surg Br. 2005;87(1):2-9.

10. Davarinos N, Ellanti P, Morris S, Mc Elwain JP. Epidemiology of pelvic and acetabular trauma in a Dublin tertiary hospital: a 10-year experience. Ir J Med Sci. 2012;181(2):243-246. doi:10.1007/s11845-011-0791-4.

11. Mauffrey C, Hao J, Cuellar DO 3rd, et al. The epidemiology and injury patterns of acetabular fractures: are the USA and China comparable? Clin Orthop Relat Res. 2014;472(11):3332-3337. doi:10.1007/s11999-014-3462-8.

12. Dente CJ, Feliciano DV, Rozycki GS, et al. The outcome of open pelvic fractures in the modern era. Am J Surg. 2005;190(6):830-835. doi:10.1016/j.amjsurg.2005.05.050.

13. Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005;36(1):1-13. doi:10.1016/j.injury.2004.05.029.

14. Gabbe BJ, de Steiger R, Esser M, Bucknill A, Russ MK, Cameron PA. Predictors of mortality following severe pelvic ring fracture: results of a population-based study. Injury. 2011;42(10):985-991. doi:10.1016/j.injury.2011.06.003.

15. Arroyo W, Nelson KJ, Belmont PJ Jr, Bader JO, Schoenfeld AJ. Pelvic trauma: what are the predictors of mortality and cardiac, venous thrombo-embolic and infectious complications following injury? Injury. 2013;44(12):1745-1749. doi:10.1016/j.injury.2013.08.007.

16. Flint L, Cryer HG. Pelvic fracture: the last 50 years. J Trauma. 2010;69(3):483-488. doi:10.1097/TA.0b013e3181ef9ce1.

17. Plaisier BR, Meldon SW, Super DM, Malangoni MA. Improved outcome after early fixation of acetabular fractures. Injury. 2000;31(2):81-84. doi:10.1016/S0020-1383(99)00233-8.

18. Centers for Disease Control and Prevention: National Hospital. Discharge survey. http://www.cdc.gov/nchs/nhds.htm. Accessed August 22, 2013.

19. Dennison C, Pokras R. Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital Health Stat. 2000;(39):1-42.

20. Centers for Disease Control and Prevention, National Center for Health Statistics. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). http://www.cdc.gov/nchs/icd/icd9cm.htm. Accessed June 18, 2013.

21. Memtsoudis SG, González Della Valle A, Besculides MC, Gaber L, Sculco TP. In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges. Clin Orthop Relat Res. 2008;466(11):2617-2627. doi:10.1007/s11999-008-0402-5.

22. Stundner O, Kirksey M, Chiu YL, et al. Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study. Psychosomatics. 2013;54(2):149-157. doi:10.1016/j.psym.2012.08.009.

23. Iezzoni LI, Daley J, Heeren T, et al. Using administrative data to screen hospitals for high complication rates. Inquiry. 1994;31(1):40-55.

24. Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients. JAMA. 1993;270(20):2478-2486.

25. Bot AG, Menendez ME, Neuhaus V, Ring D. The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty. J Shoulder Elbow Surg. 2014;23(4):519-527. doi:10.1016/j.jse.2013.12.006.

26. United States Census Bureau. Population. https://www.census.gov/topics/population.html. Accessed December 4, 2012.

27. Porter SE, Schroeder AC, Dzugan SS, Graves ML, Zhang L, Russell GV. Acetabular fracture patterns and their associated injuries. J Orthop Trauma. 2008;22(3):165-170. doi:10.1097/BOT.0b013e318165918b.

28. Centers for Disease Control and Prevention. Motorcycle Crash-Related Data. https://www.cdc.gov/motorvehiclesafety/mc/index.html Accessed September 23, 2018

29. Ragnarsson B, Jacobsson B. Epidemiology of pelvic fractures in a Swedish county. Acta Orthop Scand. 1992;63(3):297-300. doi:10.3109/17453679209154786.

30. Melton LJ 3rd, Sampson JM, Morrey BF, Ilstrup DM. Epidemiologic features of pelvic fractures. Clin Orthop Relat Res. 1981;155(155):43-47. doi:10.1097/00003086-198103000-00008.

31. al-Qahtani S, O'Connor G. Acetabular fractures before and after the introduction of seatbelt legislation. Can J Surg. 1996;39(4):317-320.

32. Ochs BG, Marintschev I, Hoyer H, et al. Changes in the treatment of acetabular fractures over 15 years: analysis of 1266 cases treated by the German Pelvic Multicentre Study Group (DAO/DGU). Injury. 2010;41(8):839-851. doi:10.1016/j.injury.2010.04.010.

33. Letournel E. Acetabulum fractures: classification and management. Clin Orthop Relat Res. 1980;151(151):81-106. doi:10.1055/s-2007-980136.

34. de Ridder VA, de Lange S, Kingma L, Hogervorst M. Results of 75 consecutive patients with an acetabular fracture. Clin Orthop Relat Res. 1994;305(305):53-57. doi:10.1097/00003086-199408000-00008.

35. Aho AJ, Isberg UK, Katevuo VK. Acetabular posterior wall fracture. 38 Cases followed for 5 years. Acta Orthop Scand. 1986;57(2):101-105. doi:10.3109/17453678609000878.

36. Stöckle U, Hoffmann R, Südkamp NP, Reindl R, Haas NP. Treatment of complex acetabular fractures through a modified extended iliofemoral approach. J Orthop Trauma. 2002;16(4):220-230. doi:10.1097/00005131-200204000-00002.

37. Tibbs BM, Kopar P, Dente CJ. Acetabular and isolated pelvic ring fractures: a comparison of initial assessment and outcome. Am Surg. 2008;74(6):538-541; discussion 541.

38. Holstein JH, Culemann U, Pohlemann T, Working Group Mortality in Pelvic Fracture Patients. What are predictors of mortality in patients with pelvic fractures? Clin Orthop Relat Res. 2012;470(8):2090-2097. doi:10.1007/s11999-012-2276-9.

39. Vallier HA, Cureton BA, Ekstein C, Oldenburg FP, Wilber JH. Early definitive stabilization of unstable pelvis and acetabulum fractures reduces morbidity. J Trauma. 2010;69(3):677-684. doi:10.1097/TA.0b013e3181e50914.

40. Enninghorst N, Toth L, King KL, McDougall D, Mackenzie S, Balogh ZJ. Acute definitive internal fixation of pelvic ring fractures in polytrauma patients: a feasible option. J Trauma. 2010;68(4):935-941. doi:10.1097/TA.0b013e3181d27b48.

41. Buller LT, Best MJ, Quinnan SM. A nationwide analysis of pelvic ring fractures: incidence and trends in treatment, length of stay, and mortality. Geriatr Orthop Surg Rehabil. 2016;7(1):9-17. doi:10.1177/2151458515616250.

42. Yoshihara H, Yoneoka D. Trends in the incidence and in-hospital outcomes of elective major orthopaedic surgery in patients eighty years of age and older in the United States from 2000 to 2009. J Bone Joint Surg Am. 2014;96(14):1185-1191. doi:10.2106/JBJS.M.01126.

43. Lo JC, Srinivasan S, Chandra M, et al. Trends in mortality following hip fracture in older women. Am J Manag Care. 2015;21(3):e206-e214.

44. Halvorson JJ, Lamothe J, Martin CR, et al. Combined acetabulum and pelvic ring injuries. J Am Acad Orthop Surg. 2014;22(5):304-314. doi:10.5435/JAAOS-22-05-304.

45. Osgood GM, Manson TT, O'Toole RV, Turen CH. Combined pelvic ring disruption and acetabular fracture: associated injury patterns in 40 patients. J Orthop Trauma. 2013;27(5):243-247. doi:10.1097/BOT.0b013e31826c2751.

46. Poole GV, Ward EF, Muakkassa FF. Pelvic fracture from major blunt trauma. Outcome is determined by associated injuries. Ann Surg. 1991;213(6):532-538; discussion 538.

47. Knöferl MW, Angele MK, Diodato MD, et al. Female sex hormones regulate macrophage function after trauma-hemorrhage and prevent increased death rate from subsequent sepsis. Ann Surg. 2002;235(1):105-112. doi:10.1097/00000658-200201000-00014.

48. Goldstein A, Phillips T, Sclafani SJ, et al. Early open reduction and internal fixation of the disrupted pelvic ring. J Trauma. 1986;26(4):325-333. doi:10.1097/00005373-198604000-00004.

49. Latenser BA, Gentilello LM, Tarver AA, Thalgott JS, Batdorf JW. Improved outcome with early fixation of skeletally unstable pelvic fractures. J Trauma. 1991;31(1):28-31. doi:10.1097/00005373-199101000-00006.

50. Riemer BL, Butterfield SL, Diamond DL, et al. Acute mortality associated with injuries to the pelvic ring: the role of early patient mobilization and external fixation. J Trauma. 1993;35(5):671-675; discussion 676.

51. Madhu R, Kotnis R, Al-Mousawi A, et al. Outcome of surgery for reconstruction of fractures of the acetabulum. The time dependent effect of delay. J Bone Joint Surg Br. 2006;88(9):1197-1203. doi:10.1302/0301-620X.88B9.17588.

52. Centers for Disease Control and Prevention. The State of Aging & Health in America 2013. https://www.cdc.gov/aging/pdf/state-aging-health-in-america-2013.pdf. Accessed December 5, 2013.

53. Bohl DD, Basques BA, Golinvaux NS, Baumgaertner MR, Grauer JN. Nationwide Inpatient Sample and National Surgical Quality Improvement Program give different results in hip fracture studies. Clin Orthop Relat Res. 2014;472(6):1672-1680. doi:10.1007/s11999-014-3559-0.

54. Memtsoudis SG. Limitations associated with the analysis of data from administrative databases. Anesthesiology. 2009;111(2):449. [author reply:450-451]. doi:10.1097/ALN.0b013e3181adf739.

55. Neuhaus V, Swellengrebel CH, Bossen JK, Ring D. What are the factors influencing outcome among patients admitted to a hospital with a proximal humeral fracture? Clin Orthop Relat Res. 2013;471(5):1698-1706. doi:10.1007/s11999-013-2876-z.

Acetabular fractures are major injuries frequently associated with life-altering sequelae¹ and a significant resulting cost to society.² Acetabular fractures are most often the result of a high-energy trauma^3-5or fall from a height.^5,6 Functional outcomes and the prevention of post-traumatic arthritis have been shown to depend upon the accuracy of operative reduction.^7-9 However, literature on the epidemiology of acetabular fractures is largely limited to European countries,^1,10 and their incidence in the United States is more poorly defined.¹¹ Published mortality rates in the existing literature vary widely from 2% to 45%,^12-14 and few studies have identified the risk factors associated with in-hospital complications.¹⁵ While age, gender, and high-velocity mechanisms have been linked to increased mortality and complications,^14-16 the evidence for these associations is poorly generalizable due to the inclusion of all pelvic fractures in these studies. Some reports suggest that advances in surgical management have improved survival and functional outcome,^15,17 but these are based upon small cohorts. Knowledge of the incidence and patterns of disease burden are crucial for the allocation of limited healthcare resources.

This study sought to describe the trends in incidence as well as the factors influencing mortality and the risk of complications for patients admitted to US hospitals with an acetabular fracture using the National Hospital Discharge Survey (NHDS), the most recently available Centers for Disease Control and Prevention data, which is also one of the largest inpatient databases in the US. Knowledge of the factors influencing outcomes for patients admitted with acetabular fractures may improve management and decrease complications.

METHODS

NATIONAL HOSPITAL DISCHARGE SURVEY

The NHDS, developed by the National Center for Healthcare Statistics division of the Centers for Disease Control and Prevention,¹⁸ was used to estimate the incidence of acetabular fractures and to evaluate the risk factors for ensuing mortality and inpatient complications. The NHDS is a publically available survey providing demographic and medical data for inpatients discharged from non-federal, short-stay hospitals in the US.¹⁹ The NHDS is the principal database used by the US government for monitoring hospital use and is considered the most comprehensive of all inpatient surgical databases in use today.¹⁹ The survey uses International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes²⁰ to classify medical diagnoses and procedures. The NHDS uses a stratified, multistage probability design to collect demographic information (age, gender, race), expected source of payment (insurance status), medical information of up to 7 discharge diagnoses and up to 4 procedures, length of care, hospital size, US region, and inpatient outcomes including discharge destination.²¹ To ensure unbiased national sampling of inpatient records, the NHDS uses a complex, 3-stage probability design including inflation by reciprocals of the probabilities of sample selection, adjustment for no response, and population weighting ratio adjustments.¹⁹ This study did not require approval by the Institutional Review Board because the NHDS is a publically available database with no patient-identifying information.

Continue to: PATIENT SELECTION...