Early operative intervention in fractured ankle patients key for optimum outcomes, lower costs

MADRID — Early operative intervention – performed even before the onset of swelling – for patients with fractured ankles would result in improved patient outcome and “significant financial savings,” according to a study presented here.

Mohamed Qaffaf presented his group’s findings at the EFORT Congress 2010.

Qaffaf added that if an operation is not feasible within 24 hours of admission and the ankle is swollen, the patient should be sent home for a period of 5-7 days with advice reducing swelling – thus permitting surgery and reducing costs.

“We have learned that treatment must be delivered in a timely fashion, especially with severe fractures,” Qaffaf said.

Analyzing relationships

The study’s aim was to analyze the relationship between the delays in surgical intervention with ankle fractures, length of hospital stay and postoperative complications.

Mohamed Qaffaf

The group performed a retrospective study of 145 consecutive patients treated for ankle fractures between January and December 2008, Qaffaf said. Results were collated, excluding talar and pilon fractures. Emergency department presentation times were noted, and time of anesthetic was used to determine surgical delay.

Qaffaf’s group also reviewed notes for inpatient stay and postoperative complications.

Delay can be costly

Qaffaf reported that out of 117 patients, 28 had their surgery delayed beyond 24 hours. Mean inpatient stay for the 117 patients in total was 3.79 days, but the 28 patients who had their surgery delayed saw a mean stay of 8.57 days.

Swelling was the cause of a postponed operation in 57% of the cases in the delayed group. Other causes included lack of theatre time and lack of fitness for surgery.

In the early group, Qaffaf said, 5 patients (4.27%) had wound infections and one patient had a chest infection (0.85%). Four patients (14.28%) from the delayed group developed wound infections.

“The ideal path is to either send the patient home for 5 to 7 days and operate on them when the swelling has come down – we can do that as a 1-day surgery – or to get them into surgery as soon as possible,” Qaffaf concluded.

“By doing that, we are preventing the high costs of the patient’s stay in the hospital and also reducing their risk of infection,” he added.

Reference:
Mohamed S, Mohamed Q, Ferrier G. Ankle fractures: Impact of swelling on timing or surgery, length of hospital stay and the economic burden. Paper #F208. Presented at the EFORT Congress 2010. June 2-5, 2010. Madrid.

This was a very interesting presentation. [Qaffaf] is looking at ankle fractures from a different perspective, which is very useful.

[Note that] ankle fractures in diabetics can often take more than 5 to 7 days for swelling to reduce … it is a very delicate population.

– Thanos Badekas, MD
Moderator