title: The risk of adverse events in orthopaedic trauma varies by anatomic region of surgery: an analysis of fifty thousand four hundred and twenty one patients.
abstract: OBJECTIVE
  Despite the high-risk nature of orthopaedic trauma, there is a dearth of data exploring adverse events following these interventions. With the current shift towards a reimbursement model grounded on episode-based payments, physicians may face financial penalties for higher rates of peri-operative complications and subsequent hospitalisations. The purpose of this study was thus to assess whether complication rates varied by anatomic region of surgery and to subsequently determine the pre-operative risk factors that elevated patients' chances of developing complications in these regions.
  
  
  METHODS
  A total of 50,421 orthopaedic trauma patients treated between 2006 and 2013 were identified in the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) database. Minor and major complications, demographics, surgical variables and pre-operative comorbidities were collected. Chi-square analyses identified pre-operative differences between the three regions. Multivariate regressions identified risk factors that significantly predicted adverse events.
  
  
  RESULTS
  Hip and pelvis (HP) patients were found to be approximately seven times more likely to develop a peri-operative complication than upper extremity (UE) patients [odds ratio (OR) 7.38, 95 % confidence interval (CI) 6.33-8.10, p < 0.001]. In addition, lower extremity (LE) patients were found to be almost three times as likely to develop any complication compared to UE patients (OR 2.80, 95 % CI 2.53-3.09, p < 0.001). Certain risk factors, such as chronic obstructive pulmonary disease (COPD) and the presence of a bleeding disorder, were significantly correlated with the development of all adverse events for all anatomic regions (p < 0.001).
  
  
  CONCLUSIONS
  There is a significant difference in complication rates between the three cohorts of orthopaedic trauma patients. In addition, the predictability of certain risk factors varied between the three regions.
  
  
  METHODS
  prognostic level II.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN, 37232, USA. manish.sethi@vanderbilt.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Adverse event; Anatomic region; Fracture; Hip; Lower extremity; Orthopaedic trauma; Pelvis; Risk factor; Upper extremity