Distal radius fractures (DRFs) are common in older adults and are typically managed conservatively, though some cases require surgical fixation. Prior studies often aggregate all geriatric patients, obscuring clinically relevant differences. Data is further limited regarding perioperative complications in those ≥80 years old. This study aimed to compare 30-day complications following ORIF for DRFs across three age cohorts (<65, 65–79, ≥80).

Using the National Surgical Quality Improvement Program (NSQIP) database, we identified adult patients who underwent ORIF for DRFs from 2015 to 2021. Patients were stratified by age group (<65, 65–79, ≥80). Primary outcomes included 30-day complications, mortality, and non-home discharge. Multivariable logistic regression adjusted for confounders including gender, BMI, ASA class, frailty (mFI-5), operative time, and wound status.

22,763 patients were included. Compared to those <65, patients aged 65–79 had higher odds of thromboembolic events (OR 5.628, p = 0.004), pulmonary complications (OR 2.188, p = 0.040), and non-home discharge (OR 1.964, p < 0.001). Patients aged ≥80 had increased odds of minor complications (OR 2.228, p = 0.011), thromboembolic events (OR 5.262, p = 0.036), and non-home discharge (OR 5.627, p < 0.001). We did not detect statistically significant differences in most complications between the 65–79 and ≥80 cohorts.

Octogenarians and nonagenarians selected for surgery still experience significantly increased risk of 30-day complications and non-home discharge following ORIF for DRFs. Due to the rarity of surgical complications and limitations with statistical power, results must be interpreted with caution. Careful patient selection and individualized decision-making remain essential even in highly active subgroups of older patients.