Hypertensive status redicts 30-day postoperative complications following open reduction internal fixation of distal radius fractures.

Abstract

Background: The primary objective of this study was to investigate the association between preoperative hypertension and postoperative complications following open reduction internal fixation of distal radius fractures.

Methods: All patients who underwent open reduction internal fixation (ORIF) for distal radius fractures (DRF) between 2015 and 2021 were queried from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Postoperative complications were reported within 30 days of procedure. We identified a total of 26,138 patients, and 31.5% (n = 8,225) of patients had hypertension. Hypertension was defined as blood pressure greater than 140/90 as documented in the medical record, requiring the use of an antihypertensive medication within 30 days of the operation. Multivariate logistic regression adjusted for all significantly associated variables was used to identify postoperative complications associated with preoperative systemic hypertension.

Results: Characteristics of patients significantly associated with systemic hypertension were age ≥ 65 (p < 0.001), female gender (p < 0.001), body mass index (BMI) ≥ 30 (p < 0.001), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), dependent functional status (p < 0.001), smoking (p < 0.001), non-insulin-dependent diabetes (p < 0.001), chronic obstructive pulmonary disease (p < 0.001), congestive heart failure (p < 0.001), chronic steroid use (p < 0.001), and bleeding disorder (p < 0.001). After controlling for significantly associated variables, postoperative complications significantly associated with systemic hypertensive status were major complication (OR 1.83, 95% CI 1.10-3.05; p = 0.020), urinary tract infection (OR 2.02, 95% CI 1.04-3.90; p = 0.037), and non-home discharge (OR 3.48, 95% CI 2.95-4.10; p < 0.001).

Clinical relevance: Preoperative hypertension requiring medication is an independent predictor for major complication, urinary tract infection, and non-home discharge following ORIF for distal radius fractures. A better understanding of preoperative risk factors, such as a patient's hypertensive status, may aid physicians to identify patients at increased risk for postoperative complications and to better counsel patients prior to management of DRF.