Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital

Abstract

Isolated operative ankle fractures are a prime target for EOC cost containment strategy protocols. Our institutional cost analysis study suggests that independent financial clinical risk factors in this treatment cohort includes podiatry as the treating surgical service and patients with an American Society of Anesthesiologists score ≥3, with the former also independently increasing total postdischarge costs in the 90-day EOC. Outpatient procedures were associated with about a one-third reduction in total costs compared to the inpatient subgroup.

Octogenarian and Nonagenarians Are at a Higher Risk for Experiencing Adverse 30-Day Outcomes Following ORIF of Ankle Fractures

“…2-year follow-up) and increased non-home discharges 18 Easterlin et al demonstrated similar findings in total knee arthroplasty (TKA) for patients recorded in the NSQIP database. Their results indicated that age was an independent risk factor for adverse outcomes following TKA after controlling for comorbid conditions.…”

“… 8 , 17 Kennedy et al described a “snowballing” of complications in some patients ≥80 years following THA, where multiple sequential adverse events can lead to rapid deterioration. Other studies of nonagenarian patients after hip fracture repair reported increased medical complications, greater risk of mortality (in-hospital through 2-year follow-up) and increased non-home discharges 18 Easterlin et al demonstrated similar findings in total knee arthroplasty (TKA) for patients recorded in the NSQIP database. Their results indicated that age was an independent risk factor for adverse outcomes following TKA after controlling for comorbid conditions.…”

“… 19 Cost savings in outpatient isolated ankle fracture repair is substantial, with a 90-day cost reduction of $5788-$8943 compared to inpatient treatment. 18 , 20 Patients also benefit from fewer readmissions and ED visits, as well as lower rates of pneumonia and acute renal failure. However, the application of outpatient fixation in the octogenarian population remains limited due to factors such as higher pre-operative comorbidity and greater fracture complexity.…”

Complications after fibula intramedullary nail fixation of pilon versus ankle fractures

“…16,17 Considering the differences in injury severity and complication rates, the benefits of fibula IMN fixation of malleolar ankle fractures may be even more pronounced in pilon fractures. 9,10,14,15 Intramedullary fibula fixation of pilon fractures has only been investigated in a few small series. Stewart et al 9 reported on distally locked fibular IMN in 23 pilon fractures and demonstrated a 100% union rate, no wound complications, no revision surgeries, and one symptomatic fibula implant removal.…”

Outpatient surgery in patients with ankle fractures minimises hospital admissions and utilisation of healthcare resources

“…However, when one study isolated cases to outpatient surgery and surgery-related complaints, this range narrowed to approximately 11-17%, with pain being amongst the most common reasons for ED presentation [19,20]. In terms of readmissions, two larger studies investigating readmissions after surgical fixation of an ankle fracture showed readmission rates varying from approximately 3-5%, with infections being reported as the most common cause in one study [21,22]. Interestingly, these results are similar with the elective orthopaedic surgery data.…”