Introduction: Open reduction and internal fixation surgeries are common procedures used to treat thoracic fractures. An abnormal coagulation profile is typically associated with adverse events post-surgery. This study seeks to analyze the relationship between coagulation profiles and complication rate/mortality in thoracic open reduction and internal fixation geriatric patients.
Methods: ACS-NSQIP was utilized to identify patients undergoing open reduction and internal fixation surgeries. A coagulopathy was defined as one of the following: high PTT, high INR, high hematocrit, low platelet count, and/or bleeding disorder. Multivariate logistic regression analysis was used to address the relationship between abnormal coagulation profiles and complications following open reduction and internal fixation procedures.
Results: 160 patients (66 M, 94F) over the age of 65 met inclusion criteria. The median patient age was 74. Males were more likely to have coagulopathies than females (p= 0.006). No significant relationship was found between age range (65-74, 75-85, 85+) and coagulopathies or between functional status levels and coagulopathies. The presence of a coagulopathy was associated with increased risk for a major complication (p=0.04) overall, and specifically with respect to reintubation (p=0.04) and sepsis (p=0.01). Upon multivariable logistic regression analysis, there was no significant association between coagulopathy and complication rate/mortality.
Conclusions: Coagulopathies are associated with an increased risk of major complications in thoracic open reduction and internal fixation surgical patients. Because geriatric patients with a thoracic fracture undergoing open surgery is a rare entity, the small sample size may potentially limit the power of the study. However, this research provide significant insight into the importance of coagulopathies as a risk factor for complications. Further studies with larger cohorts will be needed to fortify these findings.
Patient Care: Our results suggest that coagulopathies in the geriatric population are associated with an increased risk of peri-operative complications
for thoracic fracture surgical repair. Such information is important
for patient counseling.
Learning Objectives: To determine whether coagulopathy as a comorbidity is associated with a higher rate of peri-operative complications in geriatric patients undergoing surgical thoracic fracture repair.