Timing of operative intervention in the management of acutely fractured ankles and the cost implications

James, Leroy; Sookhan, N.; Subar, Daren

doi:10.1016/s0020-1383(00)00254-0

Cited by 45 publications

(38 citation statements)

References 11 publications

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“…3 There was no increase in complication rate in our re-audit group. Our findings also corroborate the findings of Breederveld 2 and James et al 6 that length of hospital stay for patients with delayed ankle fixation is clearly longer than for patients who are fixed early (Fig. 2).…”

Section: Discussionsupporting

confidence: 91%

“…6 The cost of an acute trauma bed was estimated by James et al 6 to be £225 per day. If this cost was applied to the mean difference in in-patient stay between our two preprotocol groups (early and late), then over the 12-month period the hospital would have saved £19,372 if all these patients had been operated on within the first 48 h. James et al 6 reported a mean length of stay of about 12 days. However, the overall combined mean length of stay for our pre-protocol series was about 8 days.…”

Section: Discussionmentioning

confidence: 99%

“…3 Furthermore, a number of authors have found that delaying the open reduction and internal fixation increases the complication rate. [2][3][4][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. 2,6 We 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.…”

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confidence: 99%

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Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

Pietzik

Qureshi

Langdon

et al. 2006

annals

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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).

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

Pietzik

Qureshi

Langdon

et al. 2006

annals

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“…Previous studies on early versus delayed surgical treatment mainly focus on the length of stay and the concomitant increase in costs (up to 1250 Euro per case) with a longer hospital stay [6,15,24]. Others have pointed out an improved rate of anatomical reductions in early management [7,8].…”

Section: Discussionmentioning

confidence: 99%

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

Schepers

Vries

Lieshout

et al. 2013

International Orthopaedics (SICOT)

138

105

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Purpose Information about the influence of delayed surgery on infectious wound complications is ambiguous. A clinical audit was performed to test the hypothesis that early surgery lowers the rate of infectious wound complications. Secondly we looked at the influence of surgical delay and complications on patient reported functional outcome. Methods All consecutive, closed distal fibular fractures treated surgically with a plate were included and retrospectively analysed for the delay in operation and wound complications. In a second cohort of patients with a AO-Weber Btype ankle fracture outcome was measured using the OlerudMolander ankle score (OMAS), the American Orthopaedic Foot and Ankle Society score (AOFAS) and a visual analog score (VAS) for overall satisfaction. Results Patients treated within one day experienced no wound complications (zero out of 60), whereas in the delayed group 11 % (16/145) did (p=0.004). A similar significant difference was found for the patients treated within one week (2/98) versus after one week (14/107). A systematic review of the literature showed a difference in wound complications of 3.6 % (early) versus 12.9 % (late) (p<0.0001). After 43 months, the median AOFAS was 11.5 points lower in the complication group, the OMAS 10 points, and the VAS 0.5 points, with all differences being statistically significant. Conclusions Every effort should be made to operate on closed ankle fractures as soon as reasonably possible. A delay in surgery is associated with a significant rise in infectious wound complications, which significantly lowers outcome and patient satisfaction. These fractures should preferably be treated within the first day.

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“…James et al (2001), in a retrospective analysis of patients in the United Kingdom with ankle fractures treated early (< 24 hrs) and late (> 24 hrs), found a direct cost of USD 3,396 associated with operative fixation of fractures. Our data suggest that the overall costs associated with the operations on ankle fractures (Sprague andBhandari 2002, Toivanen et al 2000).…”

Section: Discussionmentioning

confidence: 99%

A prospective cost analysis following operative treatment of unstable ankle fractures30 patients followed for 1 year

Bhandari

Sprague

Ayeni

et al. 2004

Acta Orthopaedica Scandinavica

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Background Ankle fractures remain one of the commonest injuries requiring operation. Quality of life and the overall costs associated with the treatment of such injuries are rarely reported. We did a pilot study to determine the cost of treating patients operatively with unstable ankle fractures and to measure the patientsʼ quality of life (utility scores) over time.Patients and methods 30 patients (17 men) were eligible and included in the study. They were on the average 52 (18-81) years old. All patients had type B Weber fractures (OTA 44B).Results The mean utility score from the Health Utilities Index immediately after surgery was 0.4. At 12 months follow-up, this score had increased to 0.78. The cost was, on average, USD 2,143 per patient.Interpretation Our findings indicate that patients operated on for ankle fractures had significant gains in health at an acceptable cost. These results provide data for studies of larger sample size.

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Timing of operative intervention in the management of acutely fractured ankles and the cost implications

Cited by 45 publications

References 11 publications

Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

Cost Benefit with Early Operative Fixation of Unstable Ankle Fractures

The timing of ankle fracture surgery and the effect on infectious complications; A case series and systematic review of the literature

A prospective cost analysis following operative treatment of unstable ankle fractures30 patients followed for 1 year

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