OBJECTIVES

The objective of this study was to understand patient demographics, diagnoses, intraoperative complications and healthcare utilization associated with application of multi-planar ring fixation systems (MPRF).

METHODS

This retrospective study used the Premier Hospital Billing Database to identify patients undergoing MPRF application between 2007 and 2018. Patients were grouped based on primary diagnostic categories: acquired or congenital deformity, fractures or sequela from prior fractures (deep infection, non-union, other), arthropathy, other. The Elixhauser comorbidity index, demographic and hospital variables and intraoperative (prior to discharge) complications were analyzed. Logistic regression models were developed to evaluate risk of intraoperative complications.

RESULTS

14,519 patients were included in the study. Median operating room time was 3.0 hours with significant variability within and between diagnostic categories (mean (minutes): 308.19, standard deviation (SD): 883.87). Bleeding was the most common peri-operative complications (12% of all patients), followed by dysrhythmia (7%) and infection (6%). There were significant differences in peri-operative complication rates between diagnostic categories: after adjusting for age, gender and Elixhauser comorbidity index, patients treated for congenital deformity were at significantly lower risk for all complications compared to patients treated for fractures or fracture sequelae. Adjusted odds ratios (OR) for complications in patients with fractures vs congenital deformity: for bleeding: 1.889 (95% confidence interval (CI): 1.39-2.63); for infection: 2.901 (95% CI: 1.728-5.348); for dysrhythmia: 12.959 (95%CI: 4.157-78.261). Overall 57% patients were discharged home, with again significant difference based on diagnostic category (home discharge: pediatric deformity correction: 93%, adult deformity correction: 75%, fracture: 56%, deep infection: 30%).

CONCLUSIONS

There is significant heterogeneity in patient presentation within MPRF-treated patients. Patients with fractures and fracture sequelae, often very severe, extreme cases hence requiring use of MPRF, are at far greater risks for all intraoperative complications and significantly lower rates of home discharge compared to patients treated for congenital deformity.