title: Incidence of sacral fractures and in-hospital postoperative complications in the United States: an analysis of 2002-2011 data.
abstract: METHODS
  Retrospective study of an administrative database.
  
  
  OBJECTIVE
  To estimate the incidence of sacral fractures in the United States and report short-term outcomes after their surgical management.
  
  
  BACKGROUND
  The incidence of sacral fractures in the United States is currently unknown, and these lesions have been associated with significant morbidity after their surgical management.
  
  
  METHODS
  This study used the Nationwide Inpatient Sample database for the years 2002-2011. All patients with a primary discharge diagnosis of a sacral fracture with and without a neurological injury were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Patients with a diagnosis of osteoporosis or pathological fracture were excluded. A stepwise multivariate logistic regression analysis was performed to identify factors associated with an in-hospital complication.
  
  
  RESULTS
  During the study period, 10,177 patients with a nonosteoporotic sacral fracture were identified, of whom 1002 patients underwent surgery. Between 2002 and 2011, the estimated incidence of sacral fractures increased from 0.67 per 100,000 persons to 2.09 (P < 0.001). Similarly, the rate of surgical treatment for sacral fractures increased from 0.05 per 100,000 persons in 2002 to 0.24 per 100,000 in 2011 (P < 0.001). Complications occurred in 25.95% of patients and remained steady over time (P = 0.992). Average length of stay significantly decreased from 11.93 days to 9.66 days in the 10-year period (P = 0.023). The independent factors associated with an in-hospital complication were congestive heart failure (odds ratio, 3.65; 95% confidence interval, 1.18-11.26), coagulopathy (odds ratio, 3.58; 95% confidence interval, 1.88-6.81), and electrolyte abnormalities (odds ratio, 3.28; 95% confidence interval, 2.14-5.02).
  
  
  CONCLUSIONS
  During the examined 10-year period, both the incidence of nonosteoporotic sacral fractures and the surgical treatment of these lesions increased in the United States. Between 2002 and 2011, although patient comorbidity increased, in-hospital complication rates remained stable and length of stay significantly decreased over time.
  
  
  METHODS
  4.
authors.affiliation: *The Spinal Column Biomechanics and Surgical Outcomes Laboratory and †Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Mohamad
authors.initials: M
authors.lastname: Bydon
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Garza-Ramos
authors.forename: Mohamed
authors.initials: M
authors.lastname: Macki
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Gokaslan
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006780:Hospitals, Rural / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012447:Sacrum / Q000293:injuries*; D016103:Spinal Fractures / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology