Association of Computer-Assisted Virtual Preoperative Planning With Postoperative Mortality and Complications in Older Patients With Intertrochanteric Hip Fracture
Authors: Xiaoyang Jia, Kun Zhang, Minfei Qiang, Ying Wu, Yanxi Chen
Journal: JAMA Network Open (2020)

<h3>Importance</h3> The outcomes of surgical treatment in patients with intertrochanteric hip fractures are unsatisfactory. Computer-assisted virtual preoperative planning may provide an opportunity to solve this treatment dilemma. Virtual preoperative planning is a technique based on dynamic 3-dimensional computed tomographic imaging, which allows precise evaluation of fracture details and simulation of reduction of fracture and internal fixation procedures before surgery is performed. <h3>Objective</h3> To evaluate the association of computer-assisted virtual preoperative planning with the risk of 90-day all-cause mortality and postoperative complications. <h3>Design, Setting, and Participants</h3> This retrospective cohort study was conducted from using patient data from a level 1 trauma center database. A total of 1445 patients 65 years and older with intertrochanteric hip fractures between January 1, 2009, and March 31, 2018, were identified and divided into 2 cohorts: 558 patients received computer-assisted virtual preoperative planning (virtual planning group), and 887 patients received conventional preoperative planning (conventional planning group). Of the initial 1445 patients, 224 patients (93 patients in the virtual planning group and 131 patients in the conventional planning group) were excluded, resulting in 1221 patients in the final cohort. Data were analyzed from April 5 to October 5, 2019. <h3>Exposures</h3> Computer-assisted virtual vs conventional surgical preoperative planning. <h3>Main Outcomes and Measures</h3> Primary outcomes were 90-day all-cause mortality and postoperative complications (including myocardial infarction, heart failure, stroke, kidney failure, and sepsis). Secondary outcomes were 90-day outpatient visits, hospital readmissions, and reoperations. <h3>Results</h3> Among 1221 patients who underwent hip surgery, the mean (SD) age was 73.2 (12.3) years, and 927 patients (75.9%) were women. A total of 465 patients (38.1%) were in the virtual planning group and 756 patients (61.9%) were in the conventional planning group. Among the 814 patients (407 patients in each group) who were matched by propensity score, the virtual planning group had a lower incidence of mortality (37 patients [9.1%] vs 55 patients [13.5%]; hazard ratio [HR], 0.64; 95% CI, 0.41-0.99;<i>P</i> = .04) and postoperative complications (25 patients [6.1%] vs 44 patients [10.8%]; HR, 0.54; 95% CI, 0.32-0.90;<i>P</i> = .02) compared with the conventional planning group. The incidence of outpatient visits was not substantially different in the virtual planning group (1.51 incidents per 30 person-days) compared with the conventional planning group (1.48 incidents per 30 person-days; incidence rate ratio [IRR], 0.90; 95% CI, 0.49-1.68;<i>P</i> = .75). Similar results were observed for the rate of hospital readmissions (0.99 incidents per 30 person-days in the virtual planning group and 1.01 incidents per 30 person-days in the conventional planning group; IRR, 0.91; 95% CI, 0.49-1.67;<i>P</i> = .76). However, the rate of reoperations was lower in the virtual planning group (0.76 incidents per 30 person-days) than in the conventional planning group (0.97 incidents per 30 person-days; IRR, 0.41; 95% CI, 0.22-0.76;<i>P</i> = .01). <h3>Conclusions and Relevance</h3> Among older patients with intertrochanteric hip fractures, computer-assisted virtual preoperative planning was associated with decreases in the risks of all-cause 90-day mortality, postoperative complications, and reoperations compared with conventional preoperative planning.