Risk of peripheral artery occlusive disease in patients with lower leg fracture who received fixation and non-fixation treatments: A population cohort study

• Published in: PloS one Vol. 17; no. 8; p. e0272068
• Main Authors: Shih, Pin-Keng, Chen, Jian-Xun, Lin, Mei-Chen, Wu, Shih-Chi
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 04.08.2022; Public Library of Science (PLoS)
• Subjects: Anticoagulants; Biology and Life Sciences; Cardiovascular disease; Chronic obstructive pulmonary disease; Cohort analysis; Comorbidity; Complications and side effects; Coronary artery; Coronary artery disease; Coronary vessels; Diabetes; Diabetes mellitus; Fixation; Fractures; Gout; Health risks; Heart diseases; Hypertension; Internal fixation in fractures; Leg; Medicine and Health Sciences; National health insurance; Patient outcomes; Patients; Peripheral vascular diseases; Population; Population studies; Rank tests; Risk; Risk factors; Sex; Trauma; Vein & artery diseases; Womens health; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0272068

The risk of peripheral artery occlusive disease (PAOD) in patients with lower leg fracture who underwent fixation procedures is not yet completely understood. Therefore, the current study aimed to examine the risk of subsequent PAOD in patients with lower leg fracture who received fixation and non-fixation treatments. We included 6538 patients with lower leg fracture who received non-fixation treatment and a matched cohort comprising 26152 patients who received fixation treatment from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence and risk of PAOD in patients with lower leg fracture who received fixation and non-fixation treatments were evaluated via the stratification of different characteristics and comorbidities. Non-fixation treatment, male sex, older age ([greater than or equal to] 50 years old), diabetes mellitus, and gout were associated with a significantly higher risk of lower extremity PAOD compare to each comparison group, respectively. Moreover, there was a significant correlation between fixation treatment and a lower risk of lower extremity PAOD in women (adjusted hazard ratio [aHR] = 0.58, 95% confidence interval [CI] = 0.38-0.90), women aged > 50 years (aHR = 0.61, 95% CI = 0.38-0.96), and patients with coronary artery disease (aHR = 0.43, 95% CI = (0.23-0.81). Further, patients with fixation treatment had a significantly lower risk of lower extremity PAOD within 2 years after trauma (aHR = 0.57, 95% CI = 0.34-0.97). The Kaplan-Meier analysis showed that the cumulative incidence of PAOD was significantly higher in the non-fixation treatment group than in the fixation treatment group at the end of the 10-year follow-up period (log-rank test: P = 0.022).