ABSTRACT: Introduction:Pelvic/acetabular fractures are associated with significant morbidity, mortality and cost to the society. We sought to utilize a national surgical database to assess the incidence and factors associated with prolonged length of stay (LOS), non-home discharge destination, 30-day adverse events and readmissions following surgical fixation of pelvic/acetabular fractures. Materials & methods:The 2011-2016 ACS-NSQIP database files were queried using CPT codes (27215, 27217, 27218, 27226, 27227, 27228) for patients undergoing open reduction/internal fixation (ORIF) for pelvic/acetabular fractures. Patients undergoing additional procedures for associated fractures (vertebral fractures, distal radius/ulna fractures or femoral neck/hip fractures) were excluded from the analysis to ensure that a relevant population of patients with isolated pelvic/acetabular injuries were included in the analysis. A total of 572 patients were included in the final cohort. Severe adverse events (SAE) were defined as: death, ventilator use >48?h, unplanned intubation, stroke, deep venous thrombosis, pulmonary embolism, cardiac arrest, myocardial infarction, acute renal failure, sepsis, septic shock, re-operation, deep SSI and organ/space SSI. Minor adverse events (MAE) included - wound dehiscence, superficial SSI, urinary tract infection (UTI) and progressive renal insufficiency. An extended LOS was defined as >75th centile (>9days). Results:Factors associated with AAE were partially dependent functional health status pre-operatively (p?=?0.020), transfusion ?1 unit of packed RBCs (p?=?0.001), and ASA?>?II (p?140?min (p?=?0.034) and Hct <36 pre-operatively (p?=?0.003). MAE was associated with transfusion?1 unit of packed RBCs (p?=?0.022) and ASA?>?II (p?=?0.007). Patients with an ASA?>?II (p?=?0.001), total operative time>140?min (p?9 days. Male gender (p?=?0.026), prior history of CHF (p?=?0.024), LOS >9 days (p?=?0.030) and >10% bodyweight loss in last 6 months before the procedure (p?=?0.002) were predictors of 30-day mortality. Conclusion:Patients with ASA grade?>?II, greater co-morbidity burden and prolonged operative times were likely to experience adverse events and have a longer length of stay. Surgeons can utilize this data to risk stratify patients so that appropriate pre-operative and post-operative medical optimization can take place.
