OBJECTIVES

Clinical outcomes from multi-planar ring fixation (MPRF) systems have been reported in relatively small case series, due to infrequent use. To further increase understanding of MPRF outcomes in larger populations, our study presents outcomes following MPRF application from one of the biggest claims databases in the United States.

METHODS

Patients with MPRF application were identified in the IBM Marketscan® Commercial Claims database between 2007-2018 and categorized by major diagnostic category including: acquired or congenital deformity (CD), fresh fractures or sequela from prior fractures (deep infection, non-union, other), arthropathy, other. Variables included patient demographics and comorbidities. Healthcare utilization and clinical outcomes (risk of deep and superficial infection, reoperation, amputation, and post-MPRF removal: risk of new osteotomy, fracture and new frame implantation) were analyzed up to 24 months post-application. Logistic regression models were built to evaluate risk factors for complications and generalized linear models were used to estimate payer costs.

RESULTS

12,532 patients were included. The CD cohort included only pediatric cases whereas all other cohorts included pediatric and adult subjects. For all comorbidities and outcomes, the CD cohort was significantly different than other cohorts: At time of MPRF application, major comorbidities for CD were pulmonary disease (11.3%), hearing impairment (5.9%) and other neurological disorders (4.8%). For all others, major comorbidities included uncomplicated hypertension (23.3%), uncomplicated diabetes (14.0%) and depression (9.5%). Average treatment duration was 83.3 days (SD: 72.9), with significant variability within and across diagnostic categories. Overall superficial infection was the most common complication at 23.2%, followed by deep infection (9.8%). Adjusted risk for complications were significantly lower in the CD cohort compared to all other cohorts.

CONCLUSIONS

Pediatric cases presenting for deformity correction had unique comorbidities and clinical challenges compared to all other patients. Focused research by patient type is critical to further improve patient experience and outcomes.