Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues

Abstract

Background: Ankle fracture surgeries are generally safe and effective procedures; however, as quality-based reimbursement models are increasingly affected by postoperative readmission, we aimed to determine the causes and risk factors for readmission following ankle fracture surgery. Methods: Ankle fracture cases were identified from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program from 2013 to 2014. Demographics, comorbidities, and fracture characteristics were collected. Rates of 30-day adverse events and readmissions were determined as well as the causes for readmission. Multivariable logistic regression analyses were performed to identify risk factors associated with having any adverse events and being readmitted within 30 days of surgery. Results: There were 5056 patients included; 167 (3.3%) were open fractures. The rate of any postoperative adverse event was 5.2%. There were 116 unplanned readmissions, with a readmission rate of 2.3%. Of the 116 unplanned readmissions, 49 (42.2%) were for reasons related to the surgery or surgical site, with the most common causes being deep surgical site/ hardware infections (12.9%), superficial site infections (11.2%), and wound disruption (6.9%). Most readmissions were for reasons unrelated to the surgical site (51.7%), including cardiac disorders (8.6%), pulmonary disorders (7.8%), and neurological/psychiatric disorders (6.9%). The cause of readmission was unknown for 6% of readmissions. With multivariable logistic regression, the strongest risk factors for readmission were a history of pulmonary disease (odds ratio [OR], 2.29), American Society of Anesthesiologists (ASA) class 3 (OR, 2.28), and open fractures (OR, 2.04) (all P < .05). Conclusion: In this cohort of 5056 ankle fracture cases, 2.3% of patients were readmitted within 30 days, with at least 51.7% of all unplanned readmissions due to causes unrelated to the surgery or surgical site. Predictors of readmission included a history of pulmonary disease, higher ASA class, and open fractures. Based on these findings, we advocate close medical follow-up with nonorthopaedic providers after discharge for high-risk patients. Level of Evidence: Level III.

COVID-positive ankle fracture patients are at increased odds of perioperative surgical complications following open reduction internal fixation surgery

“…This finding is consistent with prior studies that have demonstrated a similar comorbidity profile in the overall COVID patient population [26][27][28]. Additionally, the rate of comorbidities observed among COVID-negative patients in the current study is in accordance with prior ankle fracture cohort studies [29].…”

Comparison of a Potential Hospital Quality Metric With Existing Metrics for Surgical Quality–Associated Readmission

“…16 Although no studies to our knowledge have examined the overlap of the current unplanned readmission metric with surgical quality, a few studies have attempted to estimate the number of unplanned readmissions that are potentially associated with the index surgical procedure. 1 , 17 , 18 , 19 , 20 , 21 We found that 71.6% of unplanned readmissions were associated with the index surgical procedure. Rosen and colleagues estimated a smaller number (ie, 42%) that were deemed “clinically related.” 17 Another recent study in an English population found that only 53% of unplanned readmissions were “surgical readmissions” associated with the index hip replacement or knee arthroscopy.…”

“…16 Although no studies to our knowledge have examined the overlap of the current unplanned readmission metric with surgical quality, a few studies have attempted to estimate the number of unplanned readmissions that are potentially associated with the index surgical procedure. 1,[17][18][19][20][21] We found that 71.6% of unplanned readmissions were associated with the index surgical procedure.…”

“…Our findings of an unplanned readmission rate of 5.0% for knee arthroscopy and 5.4% for hip replacement match the 2014 CMS HRRP–reported unplanned readmission rate for knee arthroscopy or hip replacement (5.3%) . Although no studies to our knowledge have examined the overlap of the current unplanned readmission metric with surgical quality, a few studies have attempted to estimate the number of unplanned readmissions that are potentially associated with the index surgical procedure . We found that 71.6% of unplanned readmissions were associated with the index surgical procedure.…”

Multiple preoperative biomarkers are associated with incidence of surgical site infection following surgeries of ankle fractures

“…However, even promptly surgically treated, a certain proportion of patients would be compromised by the unfavourable outcome, and surgical site infection (SSI) was an important cause 5 . It was reported that 24.1% of the unplanned readmissions were related to SSI 6 . In addition, SSI significantly prolonged the hospitalisation stay by 6 to 12 days and increased the medical care costs 7 .…”