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Morbidity and Readmission After Open Reduction and Internal Fixation of Ankle Fractures Are Associated With Preoperative Patient Characteristics

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Ankle fractures are common and can be associated with severe morbidity. Risk factors for short-term adverse events and readmission after open reduction and internal fixation (ORIF) of ankle fractures have not been fully characterized.

Questions/purposes

The purpose of our study was to determine patient rates and risk factors for (1) any adverse event; (2) severe adverse events; (3) infectious complications; and (4) readmission after ORIF of ankle fractures.

Methods

Patients who underwent ORIF for ankle fracture from 2005 to 2012 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP®) database using International Classification of Diseases, 9th Revision and Current Procedural Terminology codes. Patients with missing perioperative data were excluded from this study. Patient characteristics were tested for association with any adverse event, severe adverse events, infectious complications, and readmission using bivariate and multivariate logistic regression analyses.

Results

Of the 4412 patients identified, 5% had an adverse event. Any adverse event was associated with insulin-dependent diabetes mellitus (IDDM; odds ratio [OR], 2.05; 95% confidence interval [CI], 1.35–3.1; p = 0.001), age ≥ 60 years (OR, 1.97; 95% CI, 1.22–3.2; p = 0.006), American Society of Anesthesiologists classification ≥ 3 (OR, 1.69; 95% CI, 1.2–2.37; p = 0.002), bimalleolar fracture (OR, 1.6; 95% CI, 1.08–2.37; p = 0.020), hypertension (OR, 1.47; 95% CI, 1.04–2.09; p = 0.031), and dependent functional status (OR, 1.47; 95% CI, 1.02–2.14; p = 0.040) on multivariate analysis. Severe adverse events occurred in 3.56% and were associated with ASA classification ≥ 3 (OR, 2.01; p = 0.001), pulmonary disease (OR, 1.9; p = 0.004), dependent functional status (OR, 1.8; p = 0.005), and hypertension (OR, 1.65; p = 0.021). Infectious complications occurred in 1.75% and were associated with IDDM (OR, 3.51; p < 0.001), dependent functional status (OR, 2.4; p = 0.002), age ≥ 60 years (OR, 2.28; p = 0.028), and bimalleolar fracture (OR, 2.19; p = 0.030). Readmission occurred in 3.17% and was associated with ASA classification ≥ 3 (OR, 2.01; p = 0.017).

Conclusions

IDDM was associated with an increased rate of adverse events after ankle fracture ORIF, whereas noninsulin-dependent diabetes mellitus was not. IDDM management deserves future study, particularly with respect to glycemic control, a potential confounder that could not be assessed with the ACS-NSQIP registry. Increased ASA class was associated with readmission, and future prospective investigations should evaluate the effectiveness of increasing the discharge threshold, discharging to extended-care facilities, and/or home nursing evaluations in this at-risk population.

Level of Evidence

Level III, prognostic study.

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave, New Haven, CT, 06510, USA

    Bryce A. Basques BS, Christopher P. Miller MD, Nicholas S. Golinvaux BA, Daniel D. Bohl MPH & Jonathan N. Grauer MD

Authors
  1. Bryce A. Basques BS
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  2. Christopher P. Miller MD
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  3. Nicholas S. Golinvaux BA
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  4. Daniel D. Bohl MPH
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  5. Jonathan N. Grauer MD
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Corresponding author

Correspondence to Jonathan N. Grauer MD.

Additional information

One or more of the authors (BAB) has received funding from the National Institutes of Health.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Basques, B.A., Miller, C.P., Golinvaux, N.S. et al. Morbidity and Readmission After Open Reduction and Internal Fixation of Ankle Fractures Are Associated With Preoperative Patient Characteristics. Clin Orthop Relat Res 473, 1133–1139 (2015). https://doi.org/10.1007/s11999-014-4005-z

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  • DOI: https://doi.org/10.1007/s11999-014-4005-z

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