In-hospital mortality from femoral shaft fracture depends on the initial delay to fracture fixation and Injury Severity Score: A retrospective cohort study from the NTDB 2002-2006

Robert Victor Cantu, Sara Catherine Graves, Kevin F. Spratt

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background: Optimal surgical timing for definitive treatment of femur fractures in severely injured patients remains controversial. This study was performed to examine in-hospital mortality for patients with femur fractures with regard to surgical timing, Injury Severity Score (ISS), and age. Methods: The National Trauma Data Bank version 7.0 was used to evaluate in-hospital mortality for patients presenting with unilateral femur fractures. Patients were stratified into four groups by surgical timing (ST) and four groups by ISS. χ tests were used to evaluate baseline interrelationships. Binary regression was used to examine the association between time to surgery, ISS score, age, and mortality after adjusting for patient medical comorbidities, and personal demographics. Results: A total of 7,540 patients met inclusion criteria, with a 1.4% overall in-hospital mortality rate. For patients with an isolated femur fracture, surgical delay beyond 48 hours was associated with nearly five times greater mortality risk compared with surgery within 12 hours (adjusted relative risk, 4.8; 95% confidence interval, 1.6-14.1). Only severely injured patients (ISS, 26+) had higher associated mortality with no delay in surgical fixation (ST1 < 12 hours) relative to ST2 of 13 hours to 24 hours with an adjusted relative risk of 4.2 (95% confidence interval, 1.0-16.7). The association between higher mortality rates and surgical delay beyond 48 hours was even stronger in the elderly patients. Conclusion: This study supports the work of previous authors who reported that early definitive fixation of femur fractures is not only beneficial, particularly in the elderly, but also consistent with more recent studies recommending at least 12-hour to 24-hour delay in fixation in severely injured patients to promote better resuscitation. Level of Evidence: Therapeutic study, level III.

Original languageEnglish (US)
Pages (from-to)1433-1440
Number of pages8
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • Damage control
  • elderly
  • femoral shaft fracture
  • mortality
  • timing

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