Demographic Drivers of Operative Time in Short and Long Cephalomedullary Nail Fixation.

Abstract

Background: Cephalomedullary nails (CMNs) are commonly used for femoral fracture fixation; however, operative times may vary based on patient-specific factors. Characterizing the influence of these factors provides important context for understanding the variability in procedure time. This study aimed to evaluate the relationship between patient demographics and operative time in CMN fixation for both long and short nail cohorts.

Methods: A retrospective review of femoral CMN cases was performed, excluding bilateral procedures. Patient demographics, including BMI, sex, and age, as well as procedure time, were collected. Procedure time was compared between short and long cohorts, and associations between procedure time and demographic variables were evaluated using nonparametric statistical methods.

Results: 744 CMN cases (421 long and 323 short) were evaluated. Procedure time was greater for long CMNs (median: 104 min, IQR: 81-133 min) compared to short (median: 62 min, IQR: 51-76 min, p<0.001). In short CMNs, obese individuals (median: 66 min, IQR: 58-86 min) had longer procedure times than overweight (median: 59 min, IQR: 49-73 min, p=0.028), and normal weight individuals (median: 61 min, IQR: 49-73 min, p=0.011). In long CMNs, obese individuals (median: 112 min, IQR: 89-148 min) had longer procedure times compared to normal weight patients (median: 97 min, IQR: 79-128 min, p=0.005), and men (median: 108 min, IQR: 88137 min) had longer procedure times than women (median: 98 min, IQR: 78-128 min, p=0.002).

Conclusion: Procedure time for CMN fixation was influenced by BMI, sex, and age. Obesity consistently contributed to increased procedure time independent of nail length. Sex and age demonstrated smaller, nail-specific associations with operative duration. Patient demographic factors should be considered when interpreting variability in operative time for CMN fixation.

Level of evidence: III.