# Declining mortality after open pelvis fracture in North America

## TL;DR

Mortality from open pelvis fractures in North America has decreased over time, possibly due to changes in treatment approaches like increased use of pelvic packing.

## Contribution

This study shows a decline in in-hospital mortality for open pelvis fractures and links it to evolving treatment practices.

## Key findings

- In-hospital mortality decreased by 0.43% per year from 2017 to 2022.
- Use of preperitoneal pelvic packing increased while exploratory laparotomy decreased over the study period.
- Mid-tier sized trauma centers reported more admissions for open pelvis fractures.

## Abstract

Open pelvis fractures are associated with a high rate of mortality and require a multidisciplinary approach to resuscitation, hemorrhage control, and fracture stabilization. The patients presenting with these injuries, practice guidelines, and use early of interventions including angioembolization (AE), exploratory laparotomy (EL), and preperitoneal pelvic packing (PPP) have changed over time. It is not known if these changes are associated with mortality.

Adults presenting with an open pelvis fracture between 2017 and 2022 were retrospectively identified from the American College of Surgeons Trauma Quality Improvement Program. The primary outcome was in-hospital mortality identified by “deceased” or “expired” emergency department or hospital discharge disposition. Patient-level adjusted risk of mortality was calculated by multivariable logistic regression considering patient comorbid conditions, injury characteristics, interventions, and facility characteristics across observed years. Adjusted mortality risk relative to AE, EL, and PPP interventions was assessed per year by Chi-square and Kruskal–Wallis tests.

Of 10,172 eligible patients identified, 81.44% were male. The mean adjusted mortality was 10.78% and significantly decreased by 0.43% per year (p = 0.001). AE was performed for 4.42% of patients and did not significantly change per year. EL was performed for 8.03% of patients and decreased by 0.60%/year (p < 0.001). PPP was performed for 7.56% of patients and increased by 0.76%/year (p < 0.001). Trauma centers of mid-tier size (400–600 beds) reported increasing admissions of open pelvis fractures.

In-hospital mortality after open pelvis fracture declined 2017–2022 as practice patterns evolved for the acute management of associated hypotension, including increased use of PPP and decreased use of EL.

Prognostic Level III.

The online version contains supplementary material available at 10.1007/s00590-025-04559-z.