Osteochondral Lesions of the Talus: Evaluation of Risk Factors and Their Impact on Postoperative Outcomes

Osteochondral lesions of the talus (OLT), also known as talar osteochondritis dissecans, is minor fracture to the articular cartilage of the talas subchondral bone it is associated with. The literature regarding its impact on patient demographics on post-operative associations of OLT-related repairs is lacking. The American College of Surgeons National Surgical Improvement Program (NSQIP) database was retrospectively reviewed, collecting data on patients with an OLT procedure between the 2008 through 2016. Univariate analysis was utilized to compare patient demographics, potential risk factors, comorbidities, hospital, and operative variables. Finally, Logistic regressions were utilized, adjusting associations of its risk factors and respective associations in a postoperative manner. A total of 491 patients with an OLT were collected for analysis. Hypertension requiring medication was a risk factor for readmission (P = 0.039) and longer lengths of stay (P = 0.021). The American Society of Anesthesiologists (ASA) classification significantly predicted increased rates of longer lengths of stay, with ASA class III being more likely than ASA class I (odds ratio [OR]: 4.8; 95% confidence interval [CI]: [1.7-14.2]; P = 0.004) or ASA class II (OR: 3.0; 95% CI [1.2-7.4]; P = 0.016) for patients to remain in hospital for longer than one day. Furthermore, patients who underwent an OLT with ASA class III underwent greater than average lengths of stay than ASA class I patients (0.54 ± 0.9 vs. 0.14 ± 0.5 days, respectively; P = 0.011). Hypertension requiring medication and ASA classification predicted, in a positive manner, postoperative complications occurring in patients with an OLT. Despite being related with extended lengths of stay, only hypertension requiring medication were associated with increased rates of readmission. Orthopaedic surgeons may use these findings to counsel patients on their risk factors and subsequently prepare themselves for peri- and post-operative complications.

The 5-factor modified frailty index (mFI-5) is predictive of 30-day postoperative complications and readmission in patients with adult spinal deformity (ASD)

BACKGROUND

There is limited research regarding the association between the mFI-5 and postoperative complications among adult spinal deformity (ASD) patients.

METHODS

Using the National Surgical Quality Improvement Project (NSQIP) database, patients with Current Procedural Terminology (CPT) codes for > 7-level fusion or < 7-level fusion with International Classification of Diseases, Ninth Revision (ICD-9) codes for ASD were identified between 2008 and 2016. Univariate analyses with post-hoc Bonferroni correction for demographics and preoperative factors were performed. Logistic regression assessed associations between mFI-5 scores and 30-day post-operative outcomes.

RESULTS

2,120 patients met criteria. Patients with an mFI-5 score of 4 or 5 were excluded, given there were<20 patients with those scores. Patients with mFI-5 scores of 1 and 2 had increased 30-day rates of pneumonia (3.5 % and 4.3 % vs 1.6 %), unplanned postoperative ventilation for > 48 h (3.1 % and 4.3 % vs 0.9 %), and UTIs (4.4 % and 7.4 % vs 2.0 %) than patients with a score of 0 (all, p < 0.05). Logistic regression revealed that compared to an mFI-5 of 0, a score of 1 was an independent predictor of 30-day reoperations (OR = 1.4; 95 % CI 1.1-18). A score of 2 was an independent predictor of overall (OR = 2.4; 95 % CI 1.4-4.1) and related (OR = 2.2; 95 % CI 1.2-4.1) 30-day readmissions. A score of 3 was not predictive of any adverse outcome.

CONCLUSION

The mFI-5 score predicted complications and postoperative events in the ASD population. The mFI-5 may effectively predict 30-day readmissions. Further research is needed to identify the benefits and predictive value of mFI-5 as a risk assessment tool.