Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures

David R. Jeffcoach, Valerie G. Sams, Christy Lawson, Blaine Enderson, Scott Smith, Heather Kline, Patrick B. Barlow, Douglas R. Wylie, Laura A. Krumenacker, James C. McMillen, Jordan Pyda, Brian Daley

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

BACKGROUND: There is a dearth of clinical data regarding the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on long-bone fracture (LBF) healing in the acute trauma setting. The orthopedic community believes that the use of NSAIDs in the postoperative period will result in poor healing and increased infectious complications. We hypothesized that, first, NSAID use would not increase nonunion/malunion and infection rates after LBF. Second, we hypothesized that tobacco use would cause higher rates of these complications. METHODS: A retrospective study of all patients with femur, tibia, and/or humerus fractures between October 2009 and September 2011 at a Level 1 academic trauma center was performed . In addition to nonunion/malunion and infection rates, patient records were reviewed for demographic data, mechanism of fracture, type of fracture, tobacco use, Injury Severity Score (ISS), comorbidities, and medications given. RESULTS: During the 24-month period, 1,901 patients experienced LBF; 231 (12.1%) received NSAIDs; and 351 (18.4%) were smokers. The overall complication rate including nonunion/malunion and infection was 3.2% (60 patients). Logistic regression analysis with adjusted odds ratios were calculated on the risk of complications given NSAID use and/or smoking, and we found that a patient is significantly more likely to have a complication if he or she received an NSAID (odds ratio, 2.17; 95% confidence interval, 1.15-4.10; p < 0.016) in the inpatient postoperative setting. Likewise, smokers are significantly more likely to have complications (odds ratio, 3.19; 95% confidence interval, 1.84-5.53; p < 0.001). CONCLUSION: LBF patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. We recommend avoiding NSAID in traumatic LBF.

Original languageEnglish (US)
Pages (from-to)779-783
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number3
DOIs
StatePublished - Mar 1 2014

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Bone Fractures
Anti-Inflammatory Agents
Infection
Pharmaceutical Preparations
Odds Ratio
Tobacco Use
Postoperative Period
Confidence Intervals
Injury Severity Score
Fracture Healing
Trauma Centers
Humerus
Tibia
Femur
Orthopedics
Comorbidity
Inpatients
Retrospective Studies
Logistic Models
Smoking

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures. / Jeffcoach, David R.; Sams, Valerie G.; Lawson, Christy; Enderson, Blaine; Smith, Scott; Kline, Heather; Barlow, Patrick B.; Wylie, Douglas R.; Krumenacker, Laura A.; McMillen, James C.; Pyda, Jordan; Daley, Brian.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 3, 01.03.2014, p. 779-783.

Research output: Contribution to journalArticle

Jeffcoach, DR, Sams, VG, Lawson, C, Enderson, B, Smith, S, Kline, H, Barlow, PB, Wylie, DR, Krumenacker, LA, McMillen, JC, Pyda, J & Daley, B 2014, 'Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures', Journal of Trauma and Acute Care Surgery, vol. 76, no. 3, pp. 779-783. https://doi.org/10.1097/TA.0b013e3182aafe0d
Jeffcoach, David R. ; Sams, Valerie G. ; Lawson, Christy ; Enderson, Blaine ; Smith, Scott ; Kline, Heather ; Barlow, Patrick B. ; Wylie, Douglas R. ; Krumenacker, Laura A. ; McMillen, James C. ; Pyda, Jordan ; Daley, Brian. / Nonsteroidal anti-inflammatory drugs' impact on nonunion and infection rates in long-bone fractures. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 76, No. 3. pp. 779-783.
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abstract = "BACKGROUND: There is a dearth of clinical data regarding the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on long-bone fracture (LBF) healing in the acute trauma setting. The orthopedic community believes that the use of NSAIDs in the postoperative period will result in poor healing and increased infectious complications. We hypothesized that, first, NSAID use would not increase nonunion/malunion and infection rates after LBF. Second, we hypothesized that tobacco use would cause higher rates of these complications. METHODS: A retrospective study of all patients with femur, tibia, and/or humerus fractures between October 2009 and September 2011 at a Level 1 academic trauma center was performed . In addition to nonunion/malunion and infection rates, patient records were reviewed for demographic data, mechanism of fracture, type of fracture, tobacco use, Injury Severity Score (ISS), comorbidities, and medications given. RESULTS: During the 24-month period, 1,901 patients experienced LBF; 231 (12.1{\%}) received NSAIDs; and 351 (18.4{\%}) were smokers. The overall complication rate including nonunion/malunion and infection was 3.2{\%} (60 patients). Logistic regression analysis with adjusted odds ratios were calculated on the risk of complications given NSAID use and/or smoking, and we found that a patient is significantly more likely to have a complication if he or she received an NSAID (odds ratio, 2.17; 95{\%} confidence interval, 1.15-4.10; p < 0.016) in the inpatient postoperative setting. Likewise, smokers are significantly more likely to have complications (odds ratio, 3.19; 95{\%} confidence interval, 1.84-5.53; p < 0.001). CONCLUSION: LBF patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. We recommend avoiding NSAID in traumatic LBF.",
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AU - Enderson, Blaine

AU - Smith, Scott

AU - Kline, Heather

AU - Barlow, Patrick B.

AU - Wylie, Douglas R.

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N2 - BACKGROUND: There is a dearth of clinical data regarding the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on long-bone fracture (LBF) healing in the acute trauma setting. The orthopedic community believes that the use of NSAIDs in the postoperative period will result in poor healing and increased infectious complications. We hypothesized that, first, NSAID use would not increase nonunion/malunion and infection rates after LBF. Second, we hypothesized that tobacco use would cause higher rates of these complications. METHODS: A retrospective study of all patients with femur, tibia, and/or humerus fractures between October 2009 and September 2011 at a Level 1 academic trauma center was performed . In addition to nonunion/malunion and infection rates, patient records were reviewed for demographic data, mechanism of fracture, type of fracture, tobacco use, Injury Severity Score (ISS), comorbidities, and medications given. RESULTS: During the 24-month period, 1,901 patients experienced LBF; 231 (12.1%) received NSAIDs; and 351 (18.4%) were smokers. The overall complication rate including nonunion/malunion and infection was 3.2% (60 patients). Logistic regression analysis with adjusted odds ratios were calculated on the risk of complications given NSAID use and/or smoking, and we found that a patient is significantly more likely to have a complication if he or she received an NSAID (odds ratio, 2.17; 95% confidence interval, 1.15-4.10; p < 0.016) in the inpatient postoperative setting. Likewise, smokers are significantly more likely to have complications (odds ratio, 3.19; 95% confidence interval, 1.84-5.53; p < 0.001). CONCLUSION: LBF patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. We recommend avoiding NSAID in traumatic LBF.

AB - BACKGROUND: There is a dearth of clinical data regarding the effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on long-bone fracture (LBF) healing in the acute trauma setting. The orthopedic community believes that the use of NSAIDs in the postoperative period will result in poor healing and increased infectious complications. We hypothesized that, first, NSAID use would not increase nonunion/malunion and infection rates after LBF. Second, we hypothesized that tobacco use would cause higher rates of these complications. METHODS: A retrospective study of all patients with femur, tibia, and/or humerus fractures between October 2009 and September 2011 at a Level 1 academic trauma center was performed . In addition to nonunion/malunion and infection rates, patient records were reviewed for demographic data, mechanism of fracture, type of fracture, tobacco use, Injury Severity Score (ISS), comorbidities, and medications given. RESULTS: During the 24-month period, 1,901 patients experienced LBF; 231 (12.1%) received NSAIDs; and 351 (18.4%) were smokers. The overall complication rate including nonunion/malunion and infection was 3.2% (60 patients). Logistic regression analysis with adjusted odds ratios were calculated on the risk of complications given NSAID use and/or smoking, and we found that a patient is significantly more likely to have a complication if he or she received an NSAID (odds ratio, 2.17; 95% confidence interval, 1.15-4.10; p < 0.016) in the inpatient postoperative setting. Likewise, smokers are significantly more likely to have complications (odds ratio, 3.19; 95% confidence interval, 1.84-5.53; p < 0.001). CONCLUSION: LBF patients who received NSAIDs in the postoperative period were twice as likely and smokers more than three times likely to suffer complications such as nonunion/malunion or infection. We recommend avoiding NSAID in traumatic LBF.

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