Associations between Early Surgery and Postoperative Outcomes in Elderly Patients with Distal Femur Fracture: A Retrospective Cohort Study

Norio Yamamoto,Tomoyuki Noda,Yosuke Tomita,Mikio Nakajima,Takashi Yorifuji,Hiroki Matsui,Yuki Miyamoto,Hiroyuki Ohbe,Yusuke Sasabuchi,Hideo Yasunaga

doi:10.3390/jcm10245800

Abstract

Previous literature has provided conflicting results regarding the associations between early surgery and postoperative outcomes in elderly patients with distal femur fractures. Using data from the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2019, we identified elderly patients who underwent surgery for distal femur fracture within two days of hospital admission (early surgery group) or at three or more days after hospital admission (delayed surgery group). Of 9678 eligible patients, 1384 (14.3%) were assigned to the early surgery group. One-to-one propensity score matched analyses showed no significant difference in 30-day mortality between the early and delayed groups (0.5% versus 0.5%; risk difference, 0.0%; 95% confidence interval, −0.7% to 0.7%). Patients in the early surgery group had significantly lower proportions of the composite outcome (death or postoperative complications), shorter hospital stays, and lower total hospitalization costs than patients in the delayed surgery group. Our results showed that early surgery within two days of hospital admission for geriatric distal femur fracture was not associated with a reduction in 30-day mortality but was associated with reductions in postoperative complications and total hospitalization costs.

Highlights

IntroductionThe incidence of distal femur fracture increases markedly with age [1]
Patients with distal femur fracture have poor postoperative outcomes because of their many perioperative complications caused by preoperative immobilization [2,3], which is similar to the case for elderly patients with hip fracture [4]
The results showed that early surgery within two days of hospital admission was not associated with a reduction in 30-day mortality but was significantly associated with reductions in postoperative complications, length of hospital stay, and total hospitalization costs

Summary

Introduction

The incidence of distal femur fracture increases markedly with age [1]. Patients with distal femur fracture were reported to have similar demographic characteristics and outcomes to elderly patients with hip fracture [2]. Patients with distal femur fracture have poor postoperative outcomes because of their many perioperative complications caused by preoperative immobilization [2,3], which is similar to the case for elderly patients with hip fracture [4]. In elderly patients with hip fracture, systematic reviews have demonstrated the beneficial effects of early surgery on postoperative outcomes, including mortality and postoperative complications [5,6]

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