Higher mortality, lower rehospitalization rates reported with conservative care of ankle fractures

Yet, researchers found that both treatments had low complication rates for older patients.

SAN DIEGO — Managing elderly patients with ankle fractures surgically produces significantly lower rates of mortality but higher rates of rehospitalization compared to conservative treatment modalities, according to a study presented here.

Kenneth J. Koval, MD, and colleagues performed an analysis of 33,704 Medicare claims for ankle fracture. The researchers found a significantly higher mortality rate at 6 months, 1 year and 2 years follow-up for patients who underwent nonoperative treatment compared to patients who were treated surgically. Yet, surgically treated patients had significantly higher rates of rehospitalization at 30 days, 6 months, 1 year and 2 years postoperatively.

Koval presented the findings at the American Academy of Orthopaedic Surgeons annual meeting.

"We found that surgical ankle fracture treatment in the elderly was associated with lower mortality than nonoperative treatment ? 6% vs. 9% at 1 year, 11% vs. 16% at 2 years ? and there's an apparent protective effect of surgical intervention for mortality," Koval said. "This may reflect selection bias, because people were operating on healthier individuals, although we held for their co-morbidity status."

The study also revealed that both of the treatment groups had a complication rate of less than 2% at all follow-up points.

"[Complication] rates after ankle fracture in the elderly were low regardless of surgery or nonoperative treatment," Koval said. "Based on these results, treatment selection for ankle fracture should not be based on fear of operative complications."

The investigators gathered information from 20% of Medicare Part B claims containing current procedural terminology codes for ankle fractures between 1998 and 2000. They analyzed the complication rates and incidence of reoperation for 2 years after treatment.

Patients were an average age of 76 years, 57% had a pre-existing comorbidity, and 33% underwent surgery. "Those who had their fractures treated surgically were younger, had fewer comorbidities and were less likely to have cardiovascular disease or diabetes, as expected," Koval added.

For more information:
Koval KJ, Zhou W, Lurie JD. Complication rates after ankle fracture in the elderly: surgical vs. nonoperative treatment. #169. Presented at the American Academy of Orthopaedic Surgeons 74th Annual Meeting. Feb. 14-18. 2007. San Diego.