Patients with Prior Solid Organ Transplant Have Increased Odds of 90-Day Medical Complications Following Open Reduction and Fixation of Ankle Fractures: A Propensity Matched Analysis

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: As the number of solid organ transplant (SOT) patients grows, the incidence of ankle fractures in this population also increases. Both pretransplant bone disease and immunosuppressive therapy cause rapid bone loss and greater fracture risk. While several studies have evaluated fractures as a whole or arthroplasty procedures, there have been no large cohort studies assessing the risk of medical complications after ankle fracture fixation in SOT patients. The purpose of this study was to fill the current gap in the literature by comparing 90-day medical complications following ankle fracture open reduction and internal fixation (ORIF) in patients with and without prior SOT. Methods: An insurance database was queried for patients who underwent unilateral ORIF of an ankle fracture. Five subgroups were created using Current Procedural Terminology- lateral malleolus, medial malleolus, bimalleolar, trimalleolar without fixation of the posterior malleolus, and trimalleolar with fixation of the posterior malleolus. Patients were excluded if they underwent arthroscopy or arthrodesis within the first 3 months of fracture, experienced an open fracture, underwent debridement, or had simultaneous hip, femur, or lower leg fractures. The study group was determined using International Classification of Diseases, Ninth and Tenth Revision, to identify patients with SOT prior to the ankle fracture. A control cohort of 10,000 people without history of SOT was used for each ankle fracture subgroup. Univariate and multivariate analyses were performed to evaluate for association between prior SOT and the incidence of 90-day medical complications after ORIF for ankle fracture using chi-square, student t-tests, and logistic regression analyses where appropriate. Results: The five cohorts included 86 patients in the lateral malleolus subgroup, 40 in the medial malleolus subgroup, 201 in the bimalleolar subgroup, 128 in the trimalleolar without posterior malleolus fixation subgroup, and 32 in the trimalleolar with posterior malleolus fixation subgroup. When controlling for demographics and comorbidities, patients who had a SOT had higher odds of renal failure, sepsis, stroke, deep vein thrombosis, urinary tract infection, and blood transfusion within 90 days of ORIF following ankle fracture when compared to those with no prior SOT (p < 0.05 for all). Conclusion: Following unilateral ORIF of ankle fracture, patients with a history of SOT are at increased odds of 90-day medical complications. When optimizing these patients, surgeons must consider the increased odds of renal, vascular, and infectious complications.