Perioperative factors affecting the occurrence of acute complex regional pain syndrome following limb bone fracture surgery: Data from the japanese diagnosis procedure combination database

Masahiko Sumitani, Hideo Yasunaga, Kanji Uchida, Hiromasa Horiguchi, Masaya Nakamura, Kazuhiko Ohe, Kiyohide Fushimi, Shinya Matsuda, Yoshitsugu Yamada

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Objective: Complex regional pain syndrome (CRPS) describes a broad spectrum of symptoms that predominantly localize to the extremities. Although limb fracture is one of the most frequently reported triggering events, few large-scale studies have shown the occurrence of and factors associated with CRPS following limb fracture. This study aimed to show the occurrence and identify of those factors. Methods: Using the Japanese Diagnosis Procedure Combination database, we identified 39 patients diagnosed with CRPS immediately after open reduction and internal fixation (ORIF) for limb fracture from a cohort of 185 378 inpatients treated with ORIF between 1 July and 31 December of each year between 2007 and 2010. Patient and clinical characteristics such as age, gender, fracture site, duration of anaesthesia and use of regional anaesthesia were investigated by logistic regression analyses to examine associations between these factors and the in-hospital occurrence of CRPS after ORIF. Results: The occurrence of CRPS was relatively high in fractures of the distal forearm, but low in fractures of the lower limb and in patients with multiple fractures. Generally females are considered to be at high risk of CRPS; however, we found a comparable number of male and female patients suffering from CRPS after ORIF for limb fracture. In terms of perioperative factors, a longer duration of anaesthesia, but not regional anaesthesia, was significantly associated with a higher incidence of CRPS. Conclusion: Although a limited number of CRPS patients were analysed in this study, reduced operative time might help to prevent the development of acute CRPS following limb fracture.

Original languageEnglish
Article numberket431
Pages (from-to)1186-1193
Number of pages8
JournalRheumatology (United Kingdom)
Issue number7
Publication statusPublished - 2014 Jul



  • Bone fracture
  • Complex regional pain syndrome
  • Factors
  • Open reduction and internal fixation
  • Regional anaesthesia

ASJC Scopus subject areas

  • Rheumatology
  • Pharmacology (medical)

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