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Study highlights risk factors for increased costs, readmissions after ankle fracture treatment
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Podiatry as the treating surgical service and American Society of Anesthesiologists score of three or more were among the risk factors for unplanned hospital readmissions in the 90-day episode of care among patients who underwent open reduction and internal fixation for ankle fractures, according to recently published results.
“As bundled payment models evolve across orthopedics, institutions should consider performing similar cost analysis studies in order to establish a proactive position,” Matthew A. Varacallo, MD, told Healio.com/Orthopedics. “Our group has previously advocated for the ‘little data’ in our popular era of ‘big data’ studies. While the latter provide excellent insight into the identification of potentially relevant clinical variables in relation to orthopedic outcomes of interest, there still remains no substitute for the value yielded from smaller institutional analyses.”
Researchers identified 299 orthopedic and podiatry patients who underwent open reduction and internal fixation for acute, isolated ankle fractures. Investigators determined independent risk factors for increasing 90-day episode of care costs and rates of unplanned hospital readmissions.
Results showed the mean index admission cost was approximately $14,048.65. Investigators noted outpatient cases were significantly cheaper vs. inpatients cases, with approximately $10,164.22 compared with $15,942.55. At 30 days, the unplanned readmission rate was 5.4%. At 90 days, the rate was 6.7%. Researchers found 65% of the unplanned readmissions were due to surgical site infections.
According to researchers, risk factors for unplanned hospital readmissions included treatment by the podiatry service and an American Society of Anesthesiologists (ASA) score of three or more. Treatment by the podiatry service and male gender were risk factors for increasing total post-discharge costs.
“First, the results of our institutional analysis suggest appropriate consideration be given to managing isolated ankle fractures in the outpatient setting,” he said. “Second, our emergency department physicians should consider our results when determining the appropriate service for referral of these types of injuries. Third, higher ASA scores were an independent risk factor for unplanned hospital readmission within 90-days after surgery.” – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.
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