Farid Alexander R, Stearns Stephen A, Atarere Joseph Okiemute, Suneja Nishant, Weaver Michael J, Von Keudell Arvind Gabriel
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Orthopaedic Trauma, Bispebjerg hospitalet, University of Copenhagen, 2400, Copenhagen, Denmark.
J Orthop. 2023 Jul 28;43:101-108. doi: 10.1016/j.jor.2023.07.028. eCollection 2023 Sep.
Non-operative management is common for low-impact pelvic fractures. In this study, we characterize the epidemiology of those treated nonoperatively following low-energy pelvic fracture, while identifying recent management trends.
Data from the Nationwide Inpatient Sample (NIS) database from 2011 to 2018 were analyzed. We identified adult patients diagnosed with pelvic fracture based on International Classification of Diseases (ICD) codes, excluding fractures of the acetabulum, femur, polytrauma, and open fractures to isolate cases caused by low-impact mechanisms. Codes indicating operative management were excluded. Demographic information and outcomes (length of stay, in-hospital mortality, hospital discharge status) were collected. Sub-analyses were performed to identify trends.
123,936 eligible patients were identified. The average age was 68.7 years. 70% were female, showing a decline from 75% to 66% over the study period. Pubic bone involvement was observed in 59% of fractures. The mean Charlson Comorbidity Index (CCI) was 3.83, corresponding to a 10-year survival rate of 58.5%, which remained relatively stable throughout the study period. 62.4% of patients received treatment at urban teaching hospitals. Average length of hospital stay was 6.3 days. Discharge to a skilled nursing facility (SNF) was the most common outcome, ranging from 62.1% to 65.0% during the study period, while 20.0% of patients were discharged home (18.4%-21.1%). Mean in-hospital mortality was 3.28%, showing no significant change, with higher rates among male patients (5.1%) and patients of Asian descent (3.8%).
The majority of patients receiving nonoperative treatment for low-energy pelvic fractures were females in their mid-60s with moderate comorbidity. The study reveals a relatively high in-hospital mortality rate of 3.28%, particularly among male patients and those of Asian descent, indicating the need for increased surveillance for further injury in these groups. Most patients were discharged to a SNF, highlighting the necessity for extended rehabilitation in this population. This persistent trend is noteworthy considering the growing emphasis on the cost of inpatient admissions and advancements in outpatient management of orthopedic injuries.
非手术治疗是低暴力骨盆骨折的常见治疗方式。在本研究中，我们描述了低能量骨盆骨折非手术治疗患者的流行病学特征，同时确定了近期的治疗趋势。
分析了2011年至2018年全国住院患者样本（NIS）数据库中的数据。我们根据国际疾病分类（ICD）编码确定诊断为骨盆骨折的成年患者，排除髋臼骨折、股骨骨折、多发伤和开放性骨折，以分离低暴力机制导致的病例。排除表明手术治疗的编码。收集人口统计学信息和结局（住院时间、院内死亡率、出院状态）。进行亚分析以确定趋势。
共确定123936例符合条件的患者。平均年龄为68.7岁。70%为女性，在研究期间从75%降至66%。59%的骨折累及耻骨。平均查尔森合并症指数（CCI）为3.83，对应10年生存率为58.5%，在整个研究期间保持相对稳定。62.4%的患者在城市教学医院接受治疗。平均住院时间为6.3天。出院至熟练护理机构（SNF）是最常见的结局，在研究期间为62.1%至65.0%，而20.0%的患者出院回家（18.4% - 21.1%）。平均院内死亡率为3.28%，无显著变化，男性患者（5.1%）和亚裔患者（3.8%）死亡率较高。
大多数接受低能量骨盆骨折非手术治疗的患者为60多岁的女性，合并症中等。该研究显示院内死亡率相对较高，为3.28%，特别是男性患者和亚裔患者，表明需要加强对这些人群进一步损伤的监测。大多数患者出院至SNF，突出了该人群延长康复的必要性。考虑到对住院费用的日益重视以及骨科损伤门诊管理的进展，这种持续趋势值得关注。
