Abstract
Background The current literature does not contain a quantitative description of the associations
between operative time and adverse outcomes after open reduction and internal fixation
(ORIF) of distal radial fractures (DRF).
Questions/Purpose We aimed to quantify associations between DRF ORIF operative time and 1) 30-day postoperative
health care utilization and 2) the incidence of local wound complications.
Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)
database was queried for DRF ORIF cases (January 2012–December 2018). A total of 17,482
cases were identified. Primary outcomes included health care utilization (length of
stay [LOS], discharge dispositions, 30-day readmissions, and reoperations) per operative-time
category. Secondary outcome was incidence of wound complications per operative-time
category. Multivariate regression was conducted to determine operative-time categories
associated with increased risk while adjusting for demographics, comorbidities, and
fracture type. Spline regression models were constructed to visualize associations.
Results The 121 to 140-minute category was associated with significantly higher risk of a
LOS > 2 days (odds ration [OR]: 1.64; 95% confidence interval [CI]:1.1–2.45; p = 0.014) and nonhome discharge (OR: 1.72; 95% CI:1.09–2.72; p = 0.02) versus 41 to 60-minute category. The ≥ 180-minute category exhibited highest
odds of LOS > 2 days (OR: 2.08; 95%CI: 1.33–3.26; p = 0.001), nonhome discharge disposition (OR: 1.87; 95% CI: 1.05–3.33; p = 0.035), and 30-day reoperation occurrence (OR: 3.52; 95% CI: 1.59–7.79; p = 0.002). There was no association between operative time and 30-day readmission
(p > 0.05 each). Higher odds of any-wound complication was first detected at 81 to 100-minute
category (OR: 3.02; 95% CI: 1.08–8.4; p = 0.035) and peaked ≥ 181 minutes (OR: 9.62; 95% CI: 2.57–36.0; p = 0.001). Spline regression demonstrated no increase in risk of adverse outcomes
if operative times were 50 minutes or less.
Conclusion Our findings demonstrate that prolonged operative time is correlated with increased
odds of health care utilization and wound complications after DRF ORIF. Operative
times greater than 60 minutes seem to carry higher odds of postoperative complications.
Keywords distal radial fractures (DRF) - complications - operative time - readmission - reoperation
- local complications
