Surgical versus nonsurgical treatment of femur fractures in people with spinal cord injury: an administrative analysis of risks

Abstract

Objective: To assess the risks associated with surgical and nonsurgical care of femur fractures in people with spinal cord injury (SCI).

Design: Retrospective cohort study; an analysis of Veterans Affairs (VA) data from the National Patient Care Database.

Setting: Administrative data from database.

Participants: The cohort was identified by searching the administrative data from fiscal years 2001 to 2006 for veterans with a femur fracture diagnosis using the International Classification of Diseases, 9th Revision, Clinical Modification codes. This group was subdivided into those with (n=396) and without (n=13,350) SCI and those treated with and without surgical intervention.

Interventions: Not applicable.

Main outcome measures: Rates of mortality and adverse events.

Results: The SCI group was younger with more distal fractures than the non-SCI group. In the non-SCI population, 78% of patients had associated surgical codes compared with 37% in the SCI population. There was higher mortality in the non-SCI group treated nonoperatively. In the SCI population, there was no difference in mortality between patients treated nonoperatively and operatively. Overall adverse events were similar between groups except for pressure sores in the SCI population, of which the nonoperative group had 20% and the operative had 7%. Rates of surgical interventions for those with SCI varied greatly among VA institutions.

Conclusions: We found lower rates of surgical intervention in the SCI population. Those with SCI who had surgery did not have increased mortality or adverse events. Surgical treatment minimizes the risks of immobilization and should be considered in appropriate SCI patients.

Keywords: Femoral fractures; General surgery; Hospitals, veterans; ICD-9-CM; International Classification of Diseases, 9th Revision, Clinical Modification; Mortality; PSI; Rehabilitation; SCI; Spinal cord injuries; VA; Veterans Affairs; patient safety indicator; spinal cord injury.