Sleep Apnea and Postoperative Medical Complications and Health Care Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Ankle Fractures

Abstract

Introduction Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures. Methods A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch’s t-tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant. Results There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P < .0001) and 90-day costs of care ($7213.12 vs $5415.79, P < .0001). Conclusion This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures. Level of Evidence Therapeutic, Level IV: Retrospective

Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review

“…Prior to elective surgery, routine screening of surgical risk factors should be performed in consultation with primary care practitioners. Providers can counsel patients with nonmodifiable risk factors 1 , 2 , 20 , 33 , 70 regarding their increased risk of perioperative complications and comprehensively evaluate for modifiable risk factors 14 , 29 , 61 , 62 , 87 , 92 , 94 so that the appropriate interventions can be prescribed. Nonmodifiable risk factors include older age, chronic medical conditions, heart disease, lung disease, vascular disease, neuropathy, and kidney disease.…”

“…Prior to elective surgery, routine screening of surgical risk factors should be performed in consultation with primary care practitioners. Providers can counsel patients with nonmodifiable risk factors 1,2,20,33,70 regarding their increased risk of perioperative complications and comprehensively evaluate for modifiable risk factors 14,29,61,62,87,92,94 Potential wound issues after surgery can be minimized by maintaining better diabetic control with routine HbA 1c and perioperative blood glucose monitoring in addition to qualified nutrition advice. Various HbA 1c cutoff values from 7.0% to 8.0% have been suggested to minimize potential complications of elective surgery in diabetic patients; however, no consensus has been reached on the optimal level.…”