Risk factors for reoperation and mortality after the operative treatment of tibial plateau fractures in Ontario, 1996-2009.

Abstract

To define the rates and risk factors for reoperation and early mortality after open reduction and internal fixation (ORIF) of a tibial plateau fracture (AO type 41A-C) with or without concomitant tibial shaft fractures. Retrospective cohort study of administrative health data (prognostic level II). Ontario, Canada. Eight thousand four hundred twenty-six patients who underwent unilateral tibial plateau ORIF between 1996 and 2009. ORIF of the tibial plateau. Reoperation included irrigation and debridement, compartment syndrome release, amputation, knee fusion, implant removal, and repeat ORIF within 1 year of the index surgery and 90-day mortality. Outcomes were fit to a multivariate logistic regression model that included patient demographics, surgical factors, and provider factors as covariates. The median cohort age was 48 years, with 51.5% male sex. Of all included plateau fractures, 27.9% were bicondylar fractures and 4.8% were open fractures. The odds of undergoing a repeat ORIF were increased significantly by the presence of an open fracture [odds ratio (OR) = 1.8, 1.3-25], bicondylar fracture (OR = 1.4, 1.2-1.7), an associated tibial shaft fracture (OR = 1.8, 1.3-2.5), surgery performed during the evening/weekend (OR = 1.24, 1.05-1.47), or surgery performed after midnight (OR = 2.08, 1.42-3.06). The odds of requiring an irrigation and debridement were also increased significantly by open fractures, bicondylar fractures, use of a temporizing external fixator, and an associated tibial shaft fracture [OR = 3.2 (2.2-4.6), 2.7 (2.1-3.5), 1.97 (1.09-3.56), and 3.2 (2.2-4.6), respectively]. The odds of repeat ORIF were significantly lower [0.8 (0.7-0.9)] when the index operation was performed in an academic center. Ninety-day mortality was 0.85% overall but 8.2% in patients older than 80 years. Markers of higher energy injury are associated with higher reoperation rates and 90-day mortality after ORIF of the tibial plateau. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.