• Paul Gilbert Fairhurst, Dionysios Tsinas, Carlos Correa Shokiche, KeelMarius Johann BaptistMJBDepartment of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.Trauma Center Hirslanden, Clinic Hirslanden, Zurich, Switzerland., Klaus Arno Siebenrock, and Johannes Dominik Bastian.
• Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
• Eur J Trauma Emerg Surg. 2021 Oct 1; 47 (5): 1313-1318.

BackgroundThe decision to treat acetabular fractures is occasionally deferred or foregone in patients perceived to be unfit for surgery. The previously validated estimation of physiologic ability and surgical stress (E-PASS) score has been shown to predict outcome in a variety of fractures, and consists of a preoperative risk score (PRS), a surgical stress score (SSS), and a comprehensive risk score (CRS).PurposeTo correlate E-PASS and its components with postoperative complication to quantify risk for individual surgical and patient factors in acetabular fracture management.MethodsA retrospective review of patient records was performed for all patients with acetabular fractures surgically treated between January 2013 and June 2018 in a level 1 Trauma Centre. Patients with multiple injuries and/or malignancies were excluded. E-PASS scores were determined with standard demographic data and subscores were correlated with complication development.ResultsOf the included 106 patients (mean age 61 years, range 17-93), complications were reported in 37 (34.9%) patients and 3 (2.8%) died. Hospital postoperative morbidity and mortality rates increased significantly with the PRS and CRS. The SSS did not correlate significantly with frequency of complications. Age was found to be the only significant independent risk factor (p value = 0.031, OR = 1.03 per year of age).ConclusionLatent patient factors have a clear influence on adverse outcomes in contrast to controllable factors such as surgical stress indicating an important role for perioperative care in reducing postoperative complications. Integrated orthogeriatric care with assessment of comorbidities, prevention or early recognition, and treatment of perioperative complications is essential.© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.

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