Clinical, nonclinical factors predict delayed fixation for 12% of distal radius fractures
Key takeaways:
- From 2010 to 2022, 12% of patients in a U.S. database underwent delayed surgery for distal radius fractures.
- Smoking status, comorbidities, insurance type and geographic region were associated with delays.
According to results of a national database study that assessed data from 2010 to 2022, 12% of patients with distal radius fractures underwent delayed surgical fixation, defined as surgery more than 2 weeks after injury.
Results showed clinical factors, such as smoking status and comorbidities, and nonclinical factors, such as insurance type and geographic region, were significant predictors of delayed surgery.
“Approximately one in 10 distal radius fractures requiring surgical intervention are being addressed outside the optimal 2-week window following injury — potentially contributing to inferior patient outcomes,” Philip P. Ratnasamy, BS, an MD/MBA candidate at Yale University, told Healio. “The strongest predictors of having delayed surgery were nonclinical, suggesting possible systemic barriers to care that should be further investigated and addressed.”
Ratnasamy and colleagues used 2010 to 2022 data from the PearlDiver database to perform a retrospective cohort study of 90,570 patients who underwent surgical fixation of a distal radius fracture within 52 weeks of initial injury.
According to the study, immediate surgery was defined as surgery performed within 2 weeks after injury, while delayed surgery was defined as surgery performed between 3 weeks and 52 weeks after injury.
Overall, 12% of patients (n = 10,887) underwent delayed surgery, while 88% of patients (n = 76,683) underwent immediate surgery.
“The 12% rate of delayed surgery in the current study was notably less than the aggregated rate of nearly 28% reported in the literature,” Ratnasamy and colleagues wrote.
Ratnasamy and colleagues found tobacco use (OR = 1.31; 95% CI, 1.2-1.42) and increased Elixhauser Comorbidity Index (OR = 1.14 per 2-point increase; 95% CI, 1.12-1.15) were clinical factors associated with delayed surgery.
Medicaid insurance (OR = 1.62; 95% CI, 1.49-1.75) and geographic regions West (OR = 1.39; 95% CI, 1.3-1.49), Northeast (OR = 1.37; 95% CI, 1.29-1.46) and South (OR = 1.21; 95% CI, 1.15-1.28) were nonclinical factors associated with delayed surgery.
“Understanding the predictors of delayed fixation of distal radius fractures can help surgeons and care teams identify at-risk patients and tailor interventions to ensure more timely surgical care,” Ratnasamy and colleagues wrote. “By addressing the disparities and barriers identified in this study, it may be possible to improve the efficiency of treatment delivery and, by extension, patient satisfaction and outcomes.”
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