Comparing surgical complications and healthcare utilization after forearm nonunion/malunion repair with or without the use of autograft

Abstract

Introduction

There is a lack of large sample data comparing short-term complications and healthcare utilization after forearm nonunion or malunion reconstruction with or without the use autograft. The purpose of this study is to compare short-term complications and healthcare utilization after forearm nonunion or malunion repair with or without the use of autograft.

Methods

All cases of radius and/or ulna nonunion/malunion repair performed between January 1, 2015 and December 31, 2020 were identified using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Patient demographics and surgical variables were reported, including sex, age, body mass index (BMI), medical comorbidities, American Society of Anesthesiologists (ASA) classification, and operative time. Outcomes of interest included unplanned hospital readmission, reoperation, non-home discharge, mortality, inpatient hospitalization, and various surgical and medical complications within 30 days of the index procedure. Categorical variables were compared using Chi squared tests, or Fisher’s exact test, when appropriate. Continuous variables were compared using unpaired t-tests. Multivariate logistic regression was used to identify variables that were independently associated with the outcomes of interest.

Results

1327 cases were included in the final cohort (617 with autograft use; 710 without autograft). The autograft group had more male patients, less patients aged 70 years and older, and a higher rate of class III obesity (p < 0.05). Otherwise, patient demographics, medical comorbidities, and ASA class were similar between groups (p > 0.05). The autograft group had longer operative times (132.9 ± 69.6 min vs. 101.3 ± 55.3 min, p < 0.05). The autograft group had a higher rate of inpatient hospitalization and surgical complications, largely driven by more wound complications (p < 0.05). Autograft use was independently associated with inpatient hospitalization (R.R. 4.306, 95% C.I.: [2.105–8.806]) and overall surgical complications (R.R. 2.475, 95% C.I.: [1.111–5.511]) (p < 0.05).

Conclusion

Forearm nonunion/malunion repair with autograft resulted in higher rates of wound complications and inpatient hospitalization compared to the non-autograft control group. Medical comorbidities, advanced age, and increased operative time were associated with various perioperative complications.

Level of evidence

III.