Predictors of unplanned reoperation after operative treatment of pelvic ring injuries

Objectives: To evaluate the incidence of unplanned reoperations after pelvic ring injuries and to develop a risk prediction model. Design: Retrospective review. Setting: Level I Trauma Center. Patients: The medical records of 913 patients (644 male and 269 female patients; mean age, 39 years; age range, 16-89 years) with unstable pelvic ring fractures operatively treated at our center from 2003 to 2015 were reviewed. Intervention: Multiple logistic regression analysis was conducted to evaluate the relative contribution of associated clinical parameters to unplanned reoperations. A risk prediction model was developed to assess the effects of multiple covariates. Main Outcome Measurements: Unplanned reoperation for infection, fixation failure, heterotopic ossification, or bleeding complication. Results: Unplanned reoperations totaled 137 fractures, with an overall rate of 15% (8% infection, 6% fixation failure, <1% heterotopic ossification, and <1% bleeding complication). Reoperations for infection and fixation failure typically occurred within the first month after the index procedure. Four independent predictors of reoperation were open fractures, combined pelvic ring and acetabular injuries, abdominal visceral injuries, and increasing pelvic fracture grade. No independent association was shown between reoperation and patient, treatment, or other injury factors. Conclusions: Unplanned reoperations were relatively common. Infection and fixation failure were the most common indications for unplanned reoperations. Factors associated with reoperation are related to severity of pelvic and abdominal visceral injuries. Our findings suggest that these complications might be inherent and in many cases unavoidable despite appropriate current treatment strategies.