The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Which Pre-Operative, Modifiable Risk Factors are Most Predictive of Complications in orthopedic Upper Extremity Surgery?

Document Type : RESEARCH PAPER

Authors
Kamil M. Amer
Dominick V. Congiusta
Akhil Dondapati
Robert L. DalCortivo
Michael M. Vosbikian
Irfan H. Ahmed
Rutgers New Jersey Medical School Department of Orthopaedics, Newark, United States
10.22038/abjs.2023.64324.3098
Abstract
Objectives: Identification of modifiable comorbid conditions in the preoperative period is important in 
optimizing outcomes. We evaluate the association between such risk factors and postoperative 
outcomes after upper extremity surgery using a national database.
Methods: The National Surgical Quality Improvement Program (NSQIP) 2006-2016 database was used to identify 
patients undergoing an upper extremity principle surgical procedure using CPT codes. Modifiable risk factors were 
defined as smoking status, use of alcohol, obesity, recent loss of >10% body weight, malnutrition, and anemia. 
Outcomes included discharge destination, major complications, bleeding complications, unplanned re-operation, 
sepsis, and prolonged length of stay. Chi square and multivariable logistic regressions were used to identify 
significant predictors of outcomes. Significance was defined as P<0.01.
Results: After applying exclusion criteria, 53,780 patients were included in the final analysis. Preoperative 
malnutrition was significantly associated with non-routine discharge (OR=4.75), major complications (OR=7.27), 
bleeding complications (OR=7.43), unplanned re-operation (OR=2.44), sepsis (OR=10.22), and prolonged length of 
stay (OR=5.27). Anemia was associated with non-routine discharge (OR=2.67), bleeding complications (OR=13.27), 
and prolonged length of stay (OR=3.26). In patients who had a weight loss of greater than 10%, there was an 
increase of non-routine discharge (OR=2.77), major complications (OR=2.93), and sepsis (OR=3.7). Smoking, 
alcohol use, and obesity were not associated with these complications.
Conclusion: Behavioral risk factors (smoking, alcohol use, and obesity) were not associated with increased 
complication rates. Malnutrition, weight loss, and anemia were associated with an increase in postoperative 
complication rates in patients undergoing upper limb orthopaedic procedures and should be addressed prior to 
surgery, suggesting nutrition labs should be part of the initial blood work.
 Level of evidence: III
Keywords
Modifiable
NSQIP
Orthopaedic
Postoperative complications
Risk factors
Upper extremity surgery
Subjects
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The Archives of Bone and Joint Surgery
Volume 12, Issue 4
April 2024
Pages 234-239

  • Receive Date 10 April 2022
  • Revise Date 21 January 2024
  • Accept Date 16 December 2023