Summary

We are reporting on trends in patient epidemiology and management decisions following non-operative treatment of low-impact pelvic fracture from 2011-2018.

Abstract

Introduction

Pelvic fractures present as a significant challenge to orthopedic surgeons, particularly regarding the initial decision of operative versus nonoperative treatment. Following low-impact mechanisms of injury, nonoperative treatment remains the more common approach for pelvic fractures. Nonetheless, operative versus nonoperative treatment of low-impact pelvic fracture, particularly lateral compression type 1 (LC1) fractures, remains debated. In this study, we aim to better characterize the epidemiology of the population treated nonoperatively following low-energy pelvic fracture, while also identifying recent trends in management of these patients from 2011-2018.

Methods

We evaluated data from the Nationwide Inpatient Sample (NIS) database, the largest all-payer inpatient care database in the United States, from 2011 to 2018. We selected for all adult patients with International Classification of Diseases (ICD) -9 or -10 diagnostic codes for pelvic fracture, excluding acetabular fracture. We then excluded patients with ICD-9 or -10 codes for operative management of pelvic fracture. Analyses were performed using RStudio version 1.4.1717. We collected data on baseline demographics (age, sex, race, cormorbidities), thromboprophylaxis regimen, and outcomes (length of stay, in-hospital mortality, hospital disposition). We conducted sub-analyses on these variables to assess for change over time.

Results

149,171 patients underwent nonoperative management of pelvic fracture from 2011-2018. Mean age was 67.2 years, and, on average, 67% were female, decreasing from 70% to 65% during our time frame. 59% of included fractures featured pubic bone involvement. Average CCI was 3.67, corresponding to a 62.7% 10-year survival rate, with a relatively stable trend. 63.9% of patients received care at an urban teaching hospital. Hospitals in the Southern region of the United States treated the highest percentage of pelvic fractures nonoperatively. Mean length of stay was 6.9 days. 62.5% of patients were discharged to a skilled nursing facility (SNF) (61.4-64.0% over this time period), while 19.8% (18.4-21.1%) were discharged home. Mean in-hospital mortality was 3.61%, stable over time, with increased mortality among men (5.4%, versus 2.7% among women) and those of Asian descent (4.4%). Regarding thromboprophylaxis, 8.2% of patients were on aspirin alone and 6.4% were on anticoagulation alone. The number of patients on either aspirin or anticoagulation increased over our time frame, with a more significant increase in use of aspirin. 2.5% of patients underwent angioembolization as part of their nonoperative management, with relatively high variability between years and no evident trend (range 2.0-3.0%).

Conclusion

Demographic trends have remained relatively stable overtime, confirming the majority of patients being treated nonoperatively following pelvic fracture are female, in their mid-60s, and with relatively low comorbidity. There was a relatively high rate of in-hospital mortality at 3.61%, particularly among male patients and patients of Asian descent, suggesting the need for higher surveillance for injury to nearby structures in patients with these characteristics. Patients were most commonly discharged to a SNF rather than home, indicating necessity for prolonged rehabilitation in this patient population. Thromboprophylaxis regimen changed overtime with decreasing frequency of patients on neither antiplatelet nor anticoagulation, and increased use of either medication alone, particularly favoring aspirin.