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Promising outcomes seen with outpatient surgery for ankle fractures
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Investigators of this study that compared inpatient and outpatient open reduction and internal fixation for ankle fractures found a reduced risk of certain 30-day medical morbidities with outpatient procedures and no differences in surgical morbidity, reoperations and readmissions.
Researchers identified patients who underwent open reduction and internal fixation (ORIF) for closed ankle fractures.
“Emergency cases, cases with preoperative sepsis or cases with open fractures were excluded as these injuries were more likely to warrant inpatient admission and, as such, did not qualify as standard closed ankle fractures that the study aimed to capture,” the researchers wrote. “The remaining patients were stratified by whether they underwent an outpatient or inpatient surgical procedure as defined by the facility at which the patient underwent the procedure.”
Researchers noted they studied patients who underwent the technique in an outpatient setting because prior evidence on this topic was mainly anecdotal.
“Although under certain circumstances inpatient admission may be unavoidable, increased scrutiny of the patient safety implications of alternative approaches to care is warranted,” they wrote. “In the absence of retrospective or prospective studies to address this question, we used the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) database to compare perioperative outcomes between properly selected cohorts of patients undergoing inpatient and outpatient ORIF,” the researchers wrote.
Investigators propensity-score matched patients who underwent an inpatient surgical procedure with patients who had an outpatient surgical procedure. Medical complications, surgical complications, readmission, and reoperation within 30 days of the surgery were among the outcomes tracked.
Findings showed a correlation between outpatient surgical procedures and lower rates of urinary tract infection, pneumonia, venous thromboembolic events and bleeding that required fusion. Investigators noted reduced 30-day medical morbidity independently correlated with outpatient status. There were no significant differences seen regarding surgical complications, unplanned reoperations and unplanned readmissions between groups. ‒ by Monica Jaramillo
Disclosures: Qin reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Alan Zhang, MD
This article demonstrates that for patients with ankle fractures who require open reduction and internal fixation, performing the surgery in an outpatient setting may offer benefits to performing the surgery in an inpatient setting. If the injury is not an open fracture or a pattern that requires emergent surgery, then performing the surgery as an outpatient procedure may lower the risk for urinary tract infections, pneumonia, venous thromboembolic events or bleeding requiring transfusion.
The clinical implication of this study is that for non-urgent ankle fractures, it may be better to perform the surgery in an outpatient surgery center instead of a hospital followed by inpatient admission. Avoiding inpatient admissions for these patients is a more cost-effective form of care and as this study demonstrates the practice to be safe and perhaps beneficial, it may lead to changes in practice patterns.
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