Impact of clinical and sociodemographic variables in development of acute compartment syndrome requiring fasciotomy after tibia fractures.

BACKGROUND: Factors like age, sex, high-energy trauma, and complex fractures are factors for acute compartment syndrome (ACS), but the influence of sociodemographic factors remains unexamined. The goal was to assess whether sociodemographic factors were independently associated with ACS requiring fasciotomy after tibia fracture when accounting for available clinical and injury-related factors. METHODS: This is a retrospective study of patients diagnosed with tibia fractures between 2016 and 2021 using the Nationwide Inpatient Sample (NIS), a 20% weighted sample of 95% of the U.S. inpatient population. The primary outcome was the rate of ACS requiring fasciotomy. RESULTS: A total of 118,769 patients were identified (weighted N = 593,845), with 2.51% (14,880) diagnosed with ACS requiring fasciotomy. There was a non-significant decrease in the rate of ACS from 2016 to 2021 (2.63% vs. 2.29%, p = 0.065). Patients with ACS requiring fasciotomy had higher hospital charges ($242,160 vs. $117,557; p < 0.001), rates of inpatient mortality (2.1% vs. 1.6%; p = 0.012) and longer length of stay (12.8 days vs. 7.03; p < 0.001). Younger age (41.6 vs. 51.4; p < 0.001), male sex (3.59% vs. 1.23%; p < 0.001), non-whites (2.87% vs. 2.31%; p < 0.001), Hispanic ethnicity (2.87% vs. 2.46%; p = 0.005), operative treatment of tibia (5.87% vs. 2.26%; p < 0.001), concurrent fibula fracture (3.19% vs. 2.06%; p < 0.001), private insurance (2.88% vs. 2.32%; p < 0.001) and hospital transfer (3.12% vs. 2.40%; p < 0.001) were associated with higher rates of ACS on bivariate analysis. Multivariate analysis showed that older age (OR = 0.288, p < 0.001) and female gender (OR = 0.430, p < 0.001) decreased risk while surgical treatment (OR = 2.358, p < 0.001) increased the risk for ACS. CONCLUSION: While sociodemographic factors have some influence in the development of ACS in patients with tibia fractures, clinical factors-like age, gender and surgical management-have a stronger influence and should primarily guide clinical suspicion and decision-making.