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- Title
Preoperative chronic steroid use as a risk factor for complications following open reduction internal fixation for proximal humerus fracture.
- Authors
Smolev, Emma; Lebens, Ryan; Leatherwood, William; Kennedy, John; Komatsu, David E.; Wang, Edward D.
- Abstract
Purpose: The primary objective of this study was to investigate the association between preoperative chronic steroid use and postoperative complications following open reduction internal fixation (ORIF) for proximal humerus fractures (PHF). Methods: The American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP) database was queried for all patients who underwent PHF ORIF between 2015 and 2021. A total of 6,273 patients were included in this study, of which 3.4% (n = 212) were in the chronic steroid use cohort. Patient characteristics including demographics, comorbidities, and 30-day postoperative complications after PHF ORIF were collected. Bivariate logistic regression and multivariate logistic regression analysis, adjusted for all significantly associated variables, was conducted to investigate the relationship between preoperative chronic steroid use and postoperative complications. Results: Chronic steroid use was significantly associated with age ≥ 75 (p < 0.001), male gender (p =0.006), dependent functional status (p = 0.008), American Society of Anesthesiologist (ASA) ≥ 3 (p < 0.001), CHF (p = 0.007), hypertension (p < 0.001), COPD (p < 0.001), bleeding disorder (p = 0.007), ascites (p = 0.040), disseminated cancer (p< 0.001), and systemic sepsis (p < 0.001). After adjusting for all significantly associated variables, chronic steroid use was independently associated with major complication (OR 1.60, 95% CI 1.06–2.43; p = 0.026), and non-home discharge (OR 1.05, 95% CI 1.01–1.08; p = 0.014). Conclusion: Preoperative chronic steroid use is associated with increasing rate of postoperative complications following PHF ORIF. Better understanding and characterizing chronic steroid use as a preoperative risk factor can aid physicians in risk stratification to reduce rates of postoperative complications following PHF ORIF. Level of evidence: III. Retrospective Cohort Comparison; Prognosis Study.
- Subjects
PREOPERATIVE period; ADRENOCORTICAL hormones; OPEN reduction internal fixation; RISK assessment; SURGERY; PATIENTS; ASCITES; LOGISTIC regression analysis; SEX distribution; HYPERTENSION; MULTIVARIATE analysis; AGE distribution; FUNCTIONAL status; HEART failure; DISCHARGE planning; DESCRIPTIVE statistics; SURGICAL complications; BONE fractures; LONGITUDINAL method; ODDS ratio; STATISTICS; SEPSIS; TUMORS; CONFIDENCE intervals; SHOULDER joint injuries; DRUG utilization; HEMORRHAGE; DISEASE risk factors
- Publication
European Journal of Orthopaedic Surgery & Traumatology, 2024, Vol 34, Issue 6, p3193
- ISSN
1633-8065
- Publication type
Article
- DOI
10.1007/s00590-024-04047-w