Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

Abstract

Ann R Coll Surg Engl 2006; 88: 405-407 405The indications for ankle fracture fixation have narrowed and we no longer operate for an isolated Weber B injury.1 It has also been well documented that unless unstable fractures are fixed early, swelling or blistering may necessitate a delay in operative fixation for up to 1 week (Fig. 1).2 In practice, it is very rare for an ankle to be too swollen to undertake operative fixation on the day of admission.3 Furthermore, a number of authors have found that delaying the open reduction and internal fixation increases the complication rate.2-5 Importantly, in-patient stay has been shown to be significantly longer in those patients who do not get operated on within the first 24 h. 2,6We reviewed our hospital in-patient stay for operative ankle fractures over a 12-month period. We subsequently introduced a fast-track system for fixation of these fractures and then closed the audit loop. The aim of the current study was to compare the length of hospital stay and complication rate pre-and post-introduction of a fast-track system to treat unstable ankle fractures operatively. Patients and MethodsA retrospective review was undertaken of all ankle fractures managed by open reduction and internal fixation over a 12-month period. The fractures were classified as unimalleolar (subgroup: medial malleolus), bimalleolar or trimalleolar. We excluded all patients who failed initial nonoperative treatment and those who presented more than 24 h after injury. The patients were divided into an early operative group (< 48 h from injury) and a late operative It has been well documented that a delay in fracture fixation results in increased length of hospital stay and increased complication rate. Initial delay can also allow swelling or blistering to develop which may necessitate a further delay in operative fixation for up to 1 week. The aim of the current study was to review the length of hospital in-patient stay for operative ankle fractures over the previous 12-month period at our hospital and compare this to the length of hospital stay following the introduction of a fast-track system for the fixation of these fractures (all fractures fixed within 48 h).

Early versus Late Surgery for Closed Ankle Fractures

“…19 In the UK, the estimated cost of an acute hospital bed per day is £225. 17 To maximise cost-effectiveness, shortening the length of hospital stay is important. 20 Based on the 2.52-day increase in postoperative length of hospital stay in our patients with delayed surgery, the estimated increased cost per patient was £567.…”

Influence of Time to Surgery in Ankle Fractures on the Rate of Complications and Length of Stay – a Multivariate Analysis

“…Miller und Kollegen untersuchten in ihrer Studie ein ähnlich großes Kollektiv von 478 Patienten, wobei sich auch hier keine Beziehung zwischen dem OP-Zeitpunkt und dem Auftreten von Komplikationen nachweisen ließ [8]. Weitere Studien erbrachten ebenfalls keinen Unterschied im Hinblick auf das Auftreten von Komplikationen in Abhängigkeit vom Operationszeitpunkt [7,14,16,17].…”

Lenght of hospitalizacion of patients with ankle fracture

“…Le~enje sve'ih preloma sko~nog zgloba mo'e biti operativno i neoperativno, što odredjuju brojni faktori 5,6 . James sa saradnicima kao i Konrating smatraju da rano operativno zbrinjavanje (do 5 dana od nastanka povrede) ne uti~e zna~ajno na ishod le~enja i pojavu komplikacija 5,7 , dok Pietzik sa saradnicima i Jensen tvrde suprotno 8,9 . Lo-gisti~ki i klini~ki faktori odredjuju termin ranog operativnog zbrinjavanja.…”