Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Sep 18, 2015; 6(8): 629-635
Published online Sep 18, 2015. doi: 10.5312/wjo.v6.i8.629
Isolated sacral injuries: Postoperative length of stay, complications, and readmission
Vasanth Sathiyakumar, Hanyuan Shi, Rachel V Thakore, Young M Lee, David Joyce, Jesse Ehrenfeld, William T Obremskey, Manish K Sethi
Vasanth Sathiyakumar, Hanyuan Shi, Rachel V Thakore, Young M Lee, David Joyce, Jesse Ehrenfeld, William T Obremskey, Manish K Sethi, the Vanderbilt Orthopaedic Institute Center for Health Policy, Medical Center East, South Tower, Nashville, TN 37232, United States
Author contributions: Sathiyakumar V, Joyce D, Obremskey WT and Sethi MK designed research; Sathiyakumar V, Shi H and Thakore RV performed research; Lee YM, Ehrenfeld J, Obremskey WT and Sethi MK contributed analytic tools; Lee YM analyzed data; Sathiyakumar V, Shi H and Thakore RV wrote the paper.
Institutional review board statement: This retrospective study was approved by the Vanderbilt University Institutional Review Board, with all data from human subjects appropriately reviewed by the study personnel.
Informed consent statement: This retrospective study was in accordance with the Vanderbilt IRB and required no active informed consent from patients. All the patients information was used in an de-identified manner.
Conflict-of-interest statement: Author William T Obremskey has previously consulted for biometrics and done expert testimony in legal matters. The institution of WTO has received a grant from the Department of Defense. For the remaining authors, none were declared.
Data sharing statement: Statistical output and dataset are available upon request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manish K Sethi, MD, the Vanderbilt Orthopaedic Institute Center for Health Policy, Medical Center East, South Tower, 1215 21st Avenue South, Suite 4200, Nashville, TN 37232, United States. manish.sethi@vanderbilt.edu
Telephone: +1-615-9360112 Fax: +1-615-3435783
Received: March 3, 2015
Peer-review started: March 4, 2015
First decision: May 13, 2015
Revised: June 17, 2015
Accepted: July 21, 2015
Article in press: July 24, 2015
Published online: September 18, 2015
Processing time: 199 Days and 9.3 Hours
Abstract

AIM: To investigate inpatient length of stay (LOS), complication rates, and readmission rates for sacral fracture patients based on operative approach.

METHODS: All patients who presented to a large tertiary care center with isolated sacral fractures in an 11-year period were included in a retrospective chart review. Operative approach (open reduction internal fixation vs percutaneous) was noted, as well as age, gender, race, and American Society of Anesthesiologists’ score. Complications included infection, nonunion and malunion, deep venous thrombosis, and hardware problems; 90-d readmissions were broken down into infection, surgical revision of the sacral fracture, and medical complications. LOS was collected for the initial admission and readmission visits if applicable. Fisher’s exact and non-parametric t-tests (Mann-Whitney U tests) were employed to compare LOS, complications, and readmissions between open and percutaneous approaches.

RESULTS: Ninety-four patients with isolated sacral fractures were identified: 31 (30.4%) who underwent open reduction and internal fixation (ORIF) vs 63 (67.0%) who underwent percutaneous fixation. There was a significant difference in LOS based on operative approach: 9.1 d for ORIF patients vs 6.1 d for percutaneous patients (P = 0.043), amounting to a difference in cost of $13590. Ten patients in the study developed complications, with no significant difference in complication rates or reasons for complications between the two groups (19.4% for ORIF patients vs 6.3% for percutaneous patients). Eight patients were readmitted, with no significant difference in readmission rates or reasons for readmission between the two groups (9.5% percutaneous vs 6.5% ORIF).

CONCLUSION: There is a significant difference in LOS based on operative approach for sacral fracture patients. Given similar complications and readmission rates, we recommend a percutaneous approach.

Keywords: Sacral fractures; Open reduction and internal fixation; Percutaneous complications; Readmissions; Length of stay

Core tip: Few studies in orthopaedics have investigated complication rates, readmission rates, and length of stay differences with respect to surgical approach for patients with sacral fractures. Investigating these issues in an era of rising healthcare costs will help determine cost-effective care. We reviewed patients presenting with isolated sacral fractures at a large, level-I trauma center, and found those treated with open reduction internal fixation stayed nearly 3 d longer compared to patients treated with percutaneous approaches. With similar complication and readmission rates between the two groups, we recommend a percutaneous approach to help lower total hospital costs for more value-based practice.