Impact of Time-to-Surgery on Adverse Outcomes for Distal Radius Fractures: A Population-Based Study
Notice bibliographique
Résumé
OBJECTIVES: To determine the optimal time window for surgical fixation of acute, isolated distal radius fractures (DRFs) in order to minimize postoperative complications. METHODS: Design: Retrospective, population-based cohort study. SETTING: Province-wide analysis using administrative health databases in Ontario, Canada. PATIENT SELECTION CRITERIA: Adult patients (≥18 years) who underwent surgical fixation for acute, isolated DRFs (OTA/AO 2R3) between 2010 and 2020 were included. Patients with open fractures, polytrauma, neurovascular injury, or fractures marked as urgent were excluded. Wait time to surgery was defined as days from emergency department presentation to operative intervention. OUTCOME MEASURES AND COMPARISONS: The primary outcome was a composite of complications including any complication or revision surgery within 10 years. Secondary outcomes included infection and revision individually. Wait time to surgery was analyzed both as a continuous variable and as a categorical variable. For the categorical analysis, patients were stratified into seven intervals (0-2, 3-5, 6-9, 10-15, 16-20, 21-25, and 26-30 days). These cut-offs were chosen to provide relatively small, evenly distributed time ranges while maintaining sufficient patient numbers within each group to ensure statistical power and model stability. This approach allowed for meaningful comparisons across the surgical wait-time spectrum while complementing the continuous analysis. Cox multivariable models were used to estimate hazard ratios (HRs), adjusting for demographics, comorbidities, fracture and fixation type, surgeon volume, and hospital type. An instrumental variable analysis using institutional wait times was performed to address confounding by indication. RESULTS: A total of 13,389 patients met inclusion criteria. Patients were predominantly female (71.2%) with a mean age of 55.7 years (Range 18-95). The 0-2 day group served as the reference and demonstrated the highest complication rates. Compared with this group, patients treated within 6-20 days had a significantly lower risk of composite complications, with the greatest benefit observed in the 6-9 day (HR 0.84, 95% CI: 0.73-0.97, P=0.02) and 10-15 day (HR 0.78, 95% CI: 0.67-0.90, P=0.001) subgroups. Infection risk was similarly lowest in the 6-15 day window, with the most favorable outcomes in the 10-15 day subgroup (HR 0.59, 95% CI: 0.41-0.84, P=0.003). Institutional-level analysis showed a 30% lower infection risk for treatment within 6-15 days compared to 1-5 days (HR 0.70, 95% CI: 0.56-0.87, P=0.002). Surgeries delayed >25 days showed a non-significant trend toward worse outcomes (HR 1.10, 95% CI: 0.75-1.32, P=0.88). CONCLUSIONS: Surgical fixation of distal radius fractures within 6-15 days was associated with the lowest observed rates of composite complications and infection. These findings suggest that this timeframe may represent an optimal window for intervention. By evaluating multiple discrete time points, this study contributes to the understanding of "when to operate," complementing prior literature focused primarily on delayed surgery. LEVEL OF EVIDENCE: Level III.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».