Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2021; 12(12): 1001-1007
Published online Dec 18, 2021. doi: 10.5312/wjo.v12.i12.1001
Rates of readmission and reoperation after operative management of midshaft clavicle fractures in adolescents
Laura A Carrillo, Hao-Hua Wu, Aman Chopra, Matt Callahan, Toshali Katyal, Ishaan Swarup
Laura A Carrillo, School of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Hao-Hua Wu, Matt Callahan, Toshali Katyal, Ishaan Swarup, Department of Orthopaedic Surgery, UCSF, San Francisco, CA 94143, United States
Aman Chopra, School of Medicine, Georgetown University School of Medicine, Washington D.C., WA 20007, United States
Author contributions: Swarup I designed the research study; Carrillo LA, Chopra A, and Callahan M collected data and performed data analysis; Carrillo LA, Chopra A, and Wu HH prepared the manuscript; Katyal T, Wu HH, and Swarup I reviewed the final manuscript.
Institutional review board statement: This study is a database study using data obtained from the Healthcare Cost and Utilization Project (HCUP). Therefore, no IRB approval letter was required.
Informed consent statement: This retrospective study was IRB exempt and no signed consent forms were required.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Ishaan Swarup, MD, Assistant Professor, Department of Orthopaedic Surgery, UCSF, 744 52nd Street, San Francisco, CA 94143, United States. ishaan.swarup@ucsf.edu
Received: January 29, 2021
Peer-review started: January 29, 2021
First decision: March 31, 2021
Revised: April 13, 2021
Accepted: October 20, 2021
Article in press: October 20, 2021
Published online: December 18, 2021
Processing time: 319 Days and 1.1 Hours
ARTICLE HIGHLIGHTS
Research background

In the past decade, there has been a shift in the paradigm for the treatment of clavicle fractures. In both adolescents and adults, the trend has been towards increasing rates of operative management.

Research motivation

It is unclear if the literature supports the superiority of open reduction internal fixation (ORIF) to nonoperative management in the management of closed midshaft clavicle fractures in adolescents.

Research objectives

The primary objective of this paper is to determine the rates of 90-d readmission and two-year reoperation after surgical management of midshaft clavicle fractures in adolescents.

Research methods

This retrospective study utilized data from the Healthcare Cost and Utilization Project State Inpatient Database for California and Florida and included patients 10–18 years of age that underwent ORIF of midshaft clavicle fracture between 2005 and 2012.

Research results

In total, 3.29% (n = 11) of patients were readmitted within 90 days to a hospital at an average of 18.91 ± 18 d after discharge, while 15.87% (n = 53) of patients underwent a reoperation within two years at an average of 209.53 ± 151 d since the index surgery. The most common reason for readmission was a postoperative infection (n < 10). Reasons for reoperation included implant removal (n = 49) at an average time of 202.39 ± 138 d after surgery, and revision ORIF (n < 10) with an average time of 297 ± 289 days after index surgery. The odds of reoperation were higher for females (P < 0.01) and outpatients (P < 0.01), while the odds of reoperation were lower for patients who underwent surgery in California (P = 0.02).

Research conclusions

There is a low rate of readmission and a high rate of reoperation after ORIF for midshaft clavicle fractures in adolescents. There are significant differences for reoperation based on patient sex, location, and hospital type.

Research perspectives

Future studies are needed to understand the applicability of the results nationally and improve the generalizability of these results. Additional prospective studies are needed to review short, mid, long-term outcomes, patient reported outcomes, and complications for the patient population.