Paul Pottanat, Carson McKoon, Joshua Morningstar, Kola George, Daniel Scott, Christopher Gross
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Patients were categorized by eGFR: end stage renal disease (ESRD) (<15 mL/min/1.73 m<sup>2</sup> [1.39 %]), severe loss of kidney function (15-30 mL/min/1.73 m<sup>2</sup> [2.32 %]), moderate loss of kidney function (30-60 mL/min/1.73 m<sup>2</sup> [15.45 %]), mild loss of kidney function (60-90 mL/min/1.73 m<sup>2</sup> [33.78 %]), normal kidney function (90-120 mL/min/1.73 m<sup>2</sup> [29.47 %]), and hyperfiltration (>120 mL/min/1.73 m<sup>2</sup> [17.57 %]). Demographics, hospital length of stay, 30-day complications, surgical site infections (SSI), Clavien-Dindo grade IV complications, readmissions, reoperations, and mortality rates were compared. The cohort was primarily female (64.5 %), with a mean age of 55.41 years (range, 16-89).</p><p><strong>Results: </strong>A total of 21,815 patients were included, with about 30 % having an eGFR of 90-120 mL/min/1.73 m², indicating \"normal\" kidney function. As eGFR decreased, patient age (p < .001), BMI (p < .001), female sex rate (p < .001), and comorbidities significantly increased. Multivariate regression analysis showed that compared to normal eGFR (>90), patients with ESRD or moderate to severe kidney loss had a significantly higher risk of complications (ESRD: OR=1.576; p = .028)(15-30: 1.978; p < .001), reoperation (ESRD: OR=1.872; p = .039)(30-60: 1.523; p = .012), and readmission (ESRD: OR=1.784; p = .013)(30-60: 1.389; p = .012).</p><p><strong>Conclusion: </strong>In patients undergoing ankle fracture ORIF, worse kidney function, as indicated by eGFR, was significantly linked to higher rates of postoperative complications, reoperation, and readmission. Surgeons and patients should take these findings into account for those with reduced kidney function.</p><p><strong>Level of evidence: </strong>Level III, Retrospective Cohort Study.</p>","PeriodicalId":48743,"journal":{"name":"Foot and Ankle Surgery","volume":" ","pages":""},"PeriodicalIF":1.9000,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Effect of kidney function on 30 day post-operative complications and mortality following ankle fracture ORIF.\",\"authors\":\"Paul Pottanat, Carson McKoon, Joshua Morningstar, Kola George, Daniel Scott, Christopher Gross\",\"doi\":\"10.1016/j.fas.2025.04.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Estimated glomerular filtration rate (eGFR) is commonly used to evaluate kidney function before surgery, but research on its impact on outcomes after ankle fracture open reduction and internal fixation (ORIF) is limited. This study aims to analyze how eGFR affects short-term complications and mortality following ankle fracture ORIF.</p><p><strong>Methods: </strong>The American College of Surgeons (ACS) NSQIP database was queried from 2005 to 2019 to identify 44,755 patients who underwent ankle fracture ORIF using specific CPT codes. Patients were excluded for missing demographic data or preoperative eGFR exceeding 3 standard deviations above the mean (91.1 mL/min/1.73 m²). Patients were categorized by eGFR: end stage renal disease (ESRD) (<15 mL/min/1.73 m<sup>2</sup> [1.39 %]), severe loss of kidney function (15-30 mL/min/1.73 m<sup>2</sup> [2.32 %]), moderate loss of kidney function (30-60 mL/min/1.73 m<sup>2</sup> [15.45 %]), mild loss of kidney function (60-90 mL/min/1.73 m<sup>2</sup> [33.78 %]), normal kidney function (90-120 mL/min/1.73 m<sup>2</sup> [29.47 %]), and hyperfiltration (>120 mL/min/1.73 m<sup>2</sup> [17.57 %]). Demographics, hospital length of stay, 30-day complications, surgical site infections (SSI), Clavien-Dindo grade IV complications, readmissions, reoperations, and mortality rates were compared. The cohort was primarily female (64.5 %), with a mean age of 55.41 years (range, 16-89).</p><p><strong>Results: </strong>A total of 21,815 patients were included, with about 30 % having an eGFR of 90-120 mL/min/1.73 m², indicating \\\"normal\\\" kidney function. As eGFR decreased, patient age (p < .001), BMI (p < .001), female sex rate (p < .001), and comorbidities significantly increased. Multivariate regression analysis showed that compared to normal eGFR (>90), patients with ESRD or moderate to severe kidney loss had a significantly higher risk of complications (ESRD: OR=1.576; p = .028)(15-30: 1.978; p < .001), reoperation (ESRD: OR=1.872; p = .039)(30-60: 1.523; p = .012), and readmission (ESRD: OR=1.784; p = .013)(30-60: 1.389; p = .012).</p><p><strong>Conclusion: </strong>In patients undergoing ankle fracture ORIF, worse kidney function, as indicated by eGFR, was significantly linked to higher rates of postoperative complications, reoperation, and readmission. 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引用次数: 0
摘要
背景：估计肾小球滤过率（eGFR）通常用于术前评估肾功能，但其对踝关节骨折切开复位内固定（ORIF）后预后影响的研究有限。本研究旨在分析eGFR对踝关节骨折ORIF术后短期并发症和死亡率的影响。方法：查询2005年至2019年美国外科医师学会（ACS） NSQIP数据库，使用特定的CPT代码识别44,755例踝关节骨折ORIF患者。患者因人口统计学资料缺失或术前eGFR超过平均值（91.1 mL/min/1.73 m²）3个标准差而被排除。病人被eGFR分类:结束阶段肾脏疾病(ESRD)(2[1.39 %]),严重肾功能丧失的(15 - 30 mL / min / 1.73平方米(2.32 %]),中度肾功能丧失的(30 - 60 mL / min / 1.73平方米(15.45 %]),轻度肾功能丧失(60 - 90 mL / min / 1.73平方米(33.78 %]),正常的肾功能(90 - 120年 mL / min / 1.73平方米(29.47 %]),和反渗透法(> 120 mL / min / 1.73平方米(17.57 %])。比较人口统计学、住院时间、30天并发症、手术部位感染（SSI）、Clavien-Dindo IV级并发症、再入院、再手术和死亡率。该队列主要为女性（64.5 %），平均年龄55.41岁（范围16-89岁）。结果：共纳入21815例患者，约30% %的患者eGFR为90 ~ 120 mL/min/1.73 m²，肾功能正常。随着eGFR的降低，患者年龄（p 90）、ESRD或中度至重度肾丢失患者发生并发症的风险显著增加(ESRD: or =1.576；p = .028)(15 - 30:1.978;p 结论：在接受踝关节骨折ORIF的患者中，eGFR显示的肾功能恶化与术后并发症、再手术和再入院的发生率显著相关。对于肾功能下降的患者，外科医生和患者应该考虑到这些发现。证据等级：III级，回顾性队列研究。
Effect of kidney function on 30 day post-operative complications and mortality following ankle fracture ORIF.
Background: Estimated glomerular filtration rate (eGFR) is commonly used to evaluate kidney function before surgery, but research on its impact on outcomes after ankle fracture open reduction and internal fixation (ORIF) is limited. This study aims to analyze how eGFR affects short-term complications and mortality following ankle fracture ORIF.
Methods: The American College of Surgeons (ACS) NSQIP database was queried from 2005 to 2019 to identify 44,755 patients who underwent ankle fracture ORIF using specific CPT codes. Patients were excluded for missing demographic data or preoperative eGFR exceeding 3 standard deviations above the mean (91.1 mL/min/1.73 m²). Patients were categorized by eGFR: end stage renal disease (ESRD) (<15 mL/min/1.73 m2 [1.39 %]), severe loss of kidney function (15-30 mL/min/1.73 m2 [2.32 %]), moderate loss of kidney function (30-60 mL/min/1.73 m2 [15.45 %]), mild loss of kidney function (60-90 mL/min/1.73 m2 [33.78 %]), normal kidney function (90-120 mL/min/1.73 m2 [29.47 %]), and hyperfiltration (>120 mL/min/1.73 m2 [17.57 %]). Demographics, hospital length of stay, 30-day complications, surgical site infections (SSI), Clavien-Dindo grade IV complications, readmissions, reoperations, and mortality rates were compared. The cohort was primarily female (64.5 %), with a mean age of 55.41 years (range, 16-89).
Results: A total of 21,815 patients were included, with about 30 % having an eGFR of 90-120 mL/min/1.73 m², indicating "normal" kidney function. As eGFR decreased, patient age (p < .001), BMI (p < .001), female sex rate (p < .001), and comorbidities significantly increased. Multivariate regression analysis showed that compared to normal eGFR (>90), patients with ESRD or moderate to severe kidney loss had a significantly higher risk of complications (ESRD: OR=1.576; p = .028)(15-30: 1.978; p < .001), reoperation (ESRD: OR=1.872; p = .039)(30-60: 1.523; p = .012), and readmission (ESRD: OR=1.784; p = .013)(30-60: 1.389; p = .012).
Conclusion: In patients undergoing ankle fracture ORIF, worse kidney function, as indicated by eGFR, was significantly linked to higher rates of postoperative complications, reoperation, and readmission. Surgeons and patients should take these findings into account for those with reduced kidney function.
Level of evidence: Level III, Retrospective Cohort Study.
期刊介绍：
Foot and Ankle Surgery is essential reading for everyone interested in the foot and ankle and its disorders. The approach is broad and includes all aspects of the subject from basic science to clinical management. Problems of both children and adults are included, as is trauma and chronic disease. Foot and Ankle Surgery is the official journal of European Foot and Ankle Society.
The aims of this journal are to promote the art and science of ankle and foot surgery, to publish peer-reviewed research articles, to provide regular reviews by acknowledged experts on common problems, and to provide a forum for discussion with letters to the Editors. Reviews of books are also published. Papers are invited for possible publication in Foot and Ankle Surgery on the understanding that the material has not been published elsewhere or accepted for publication in another journal and does not infringe prior copyright.
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