Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Ankle fracture is one of the most common injuries treated by orthopaedic surgeons, and its incidence is only expected to rise with an aging population. It is also associated with often costly complications, yet there is little literature on risk factors, especially modifiable ones, driving these complications. The aim of this study is to reveal whether inpatient treatment after ankle fracture is associated with higher incidence of postoperative complications. As the USA moves towards a bundled payment healthcare system, it is imperative that orthopaedists maximize patient outcome and quality of care while also reducing overall costs.
We used the American College of Surgeons National Surgical Quality Improvement Program database to compare complication rates between inpatient and outpatient treatment of ankle fracture. We collected patient demographics, comorbidities, and postoperative complications from both groups, then compared treatments using a multinomial logistic regression model.
We identified 7383 patients, with 2630 (36%) in the outpatient and 2630 (36%) in the inpatient group. Of these, 104 (4.0%) inpatients compared with 52 (2.0%) outpatients developed a complication (p < 0.001).
Inpatients developed major complications including deep wound infection and pulmonary embolism, as well as minor complications such as pneumonia and urinary tract infection, at significantly greater rates. As reimbursement models begin to incorporate value-based care, orthopaedic surgeons need to be aware of factors associated with increased incidence of postoperative complications.
Level III retrospective comparative study.
Centers for Medicare and Medicaid Services. Baltimore (MD). National Health Expenditures 2013 Highlights (2013) http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf. Accessed 9 Apr 2015
Andrés-Cano P, Godino M, Vides M, Guerado E (2015) Postoperative complications of anterior cruciate ligament reconstruction after ambulatory surgery. Rev Esp Cir Octop Traumatol 59(3):157–164. doi: 10.1016/j.recot.2014.09.001
Bibbo C, Lin SS, Beam HA, Behrens FF (2001) Complications of ankle fractures in diabetic patients. Orthop Clin N Am 32(1):113–133 CrossRef
Scott AM (2010) Diagnosis and treatment of ankle fractures. Radiol Technol 81(5):457–475 PubMed
Ganesh SP, Pietrobon R, Cecílio WA, Pan D, Lightdale N, Nunley JA (2005) The impact of diabetes on patient outcomes after ankle fracture. J Bone Joint Surg Am 87(8):1712–1718 PubMed
Medicare.gov. Are you a hospital inpatient or outpatient? (2014) https://www.medicare.gov/Pubs/pdf/11435.pdf. Accessed 9 Apr 2015
- Open treatment of ankle fracture as inpatient increases risk of complication
Michelle S. Shen
Ashley C. Dodd
A. Alex Jahangir
Manish K. Sethi
- Springer International Publishing
Neu im Fachgebiet Orthopädie und Unfallchirurgie
Mail Icon II