Comparative Study of Early Health Care Use after Forearm Corrective Osteotomy
26 May 2018
03 December 2018
15 January 2019 (eFirst)
Background Bone reconstruction is frequently required for corrective osteotomy of the forearm long bones. Studies have evaluated long term outcomes but not the impact of these procedures on early postoperative complications and health care utilization.
Questions/Purposes This study evaluated the early postoperative health care utilization following corrective osteotomy of the radius and/or ulna.
Patients and Methods The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) was the primary data source to perform a comparative statistical analysis of the bone autograft and nonautograft (allograft, graft substitute, or no graft) procedures. We performed a review of the NSQIP database (2005–2013) to evaluate patients who underwent a corrective osteotomy of the radius and/or ulna.
Results There were 362 cases; autograft (n = 117) and nonautograft (n = 245). There were no significant differences with demographics or comorbidities. The majority of cases were outpatient surgeries and there were no significant differences in anesthesia time, operative time, or hospital length of stay. Overall, the average length of stay was 0.6 days, readmission rate was 2%, and the total complication rate was 1% and there was no statistically significant difference between reconstruction groups. Harvesting of autograft was not associated with the overall 30-day complications and specific markers of health care utilization.
Conclusions Our results are derived from the heterogeneous hospital setting of NSQIP contributing centers. The health care utilization and 30-day complications are low following corrective osteotomy of forearm long bones and autograft harvest did not influence the health care utilization.
Level of Evidence Therapeutic Level II.
- 1 Conway JD. Autograft and nonunions: morbidity with intramedullary bone graft versus iliac crest bone graft. Orthop Clin North Am 2010; 41 (01) 75-84
- 2 Mugnai R, Tarallo L, Lancellotti E. , et al. Corrective osteotomies of the radius: grafting or not?. World J Orthop 2016; 7 (02) 128-135
- 3 Giannoudis PV, Dinopoulos H, Tsiridis E. Bone substitutes: an update. Injury 2005; 36 (Suppl, 3): S20-S27
- 4 Ozer K, Chung KC. The use of bone grafts and substitutes in the treatment of distal radius fractures. Hand Clin 2012; 28 (02) 217-223
- 5 Dahabreh Z, Calori GM, Kanakaris NK, Nikolaou VS, Giannoudis PV. A cost analysis of treatment of tibial fracture nonunion by bone grafting or bone morphogenetic protein-7. Int Orthop 2009; 33 (05) 1407-1414
- 6 Rajan GP, Fornaro J, Trentz O, Zellweger R. Cancellous allograft versus autologous bone grafting for repair of comminuted distal radius fractures: a prospective, randomized trial. J Trauma 2006; 60 (06) 1322-1329
- 7 Luchetti R. Corrective osteotomy of malunited distal radius fractures using carbonated hydroxyapatite as an alternative to autogenous bone grafting. J Hand Surg Am 2004; 29 (05) 825-834
- 8 Ekrol I, Hajducka C, Court-Brown C, McQueen MM. A comparison of RhBMP-7 (OP-1) and autogenous graft for metaphyseal defects after osteotomy of the distal radius. Injury 2008; 39 (Suppl, 2): S73-S82
- 9 Ozer K, Kiliç A, Sabel A, Ipaktchi K. The role of bone allografts in the treatment of angular malunions of the distal radius. J Hand Surg Am 2011; 36 (11) 1804-1809
- 10 Ko CY, Hall BL, Hart AJ, Cohen ME, Hoyt DB. The American College of Surgeons National Surgical Quality Improvement Program: achieving better and safer surgery. Jt Comm J Qual Patient Saf 2015; 41 (05) 199-204
- 11 Wada T, Tatebe M, Ozasa Y. , et al. Clinical outcomes of corrective osteotomy for distal radial malunion: a review of opening and closing-wedge techniques. J Bone Joint Surg Am 2011; 93 (17) 1619-1626