Is lateral femoral nailing associated with increased intensive care unit days? A propensity-matched analysis of 848 cases

G. Bradley Reahl, Nathan N. O’Hara, Max Coale, Lyndsay M. O’Hara, Renan Carlos Castillo, V. O’Toole, Gerard P. Slobogean

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study is to determine if lateral patient position during femoral nailing is associated with increases in intensive care unit (ICU) length of stay (LOS) or ventilator days when compared with femoral nailing in a supine position. Design: Retrospective cohort study. Setting: Level 1 trauma center. Patients/Participants: Patients with femoral shaft fractures treated with intramedullary fixation were identified. Propensity matching was performed to minimize selection bias using factors thought to be associated with surgeon selection of supine nailing at our institution (Injury Severity Score, Abbreviated Injury Score brain, and bilateral fractures). After matching, 848 patients were included in the analysis. Intervention: Femoral nailing in the lateral position compared with the supine position. Main Outcome Measurements: Our primary outcome measure was ICU LOS. Ventilator days were the secondary outcome. Results: Treating patients with femoral nailing in the lateral position was associated with a 1.88 days (95% confidence interval, 0.73–3.02; P = 0.001) reduction in ICU LOS in our adjusted model. Intramedullary nailing in the lateral position was associated with a 1.29 days (95% confidence interval, 20.12 to 2.69) decrease in postoperative time on a ventilator. However, this finding was not statistically significant (P = 0.07). Conclusion: Lateral femoral nailing was associated with decreased ICU LOS (P = 0.001) even after accounting for selection bias using propensity score matching. Our data indicate that lateral femoral nailing is likely not associated with the increased risk of pulmonary complication.

Original languageEnglish (US)
Pages (from-to)39-42
Number of pages4
JournalJournal of Orthopaedic Trauma
Volume32
Issue number1
DOIs
StatePublished - Jan 1 2018

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Thigh
Intensive Care Units
Length of Stay
Mechanical Ventilators
Selection Bias
Supine Position
Confidence Intervals
Intramedullary Fracture Fixation
Propensity Score
Injury Severity Score
Femoral Fractures
Trauma Centers
Brain Injuries
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Lung

Keywords

  • Femur
  • Fracture
  • Intramedullary nail
  • Patient position
  • Pulmonary complication

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Is lateral femoral nailing associated with increased intensive care unit days? A propensity-matched analysis of 848 cases. / Bradley Reahl, G.; O’Hara, Nathan N.; Coale, Max; O’Hara, Lyndsay M.; Castillo, Renan Carlos; O’Toole, V.; Slobogean, Gerard P.

In: Journal of Orthopaedic Trauma, Vol. 32, No. 1, 01.01.2018, p. 39-42.

Research output: Contribution to journalArticle

Bradley Reahl, G. ; O’Hara, Nathan N. ; Coale, Max ; O’Hara, Lyndsay M. ; Castillo, Renan Carlos ; O’Toole, V. ; Slobogean, Gerard P. / Is lateral femoral nailing associated with increased intensive care unit days? A propensity-matched analysis of 848 cases. In: Journal of Orthopaedic Trauma. 2018 ; Vol. 32, No. 1. pp. 39-42.
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