Associate Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX; Assistant Professor, Department of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, TX.
Associate Professor, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):239-245. doi: 10.1053/j.jfas.2019.08.003.
Although fractures of the ankle are common injuries treated by surgical podiatrists and orthopaedic surgeons specializing in foot and ankle surgery, postoperative complications can occur, often imposing an economic burden on the patient. As health care in the United States moves toward value-based care, cost reduction has primarily focused on reducing complications and unplanned episodes of care. We used a large modern database of insurance claims to examine patterns of complications after open reduction internal fixation of ankle fractures, identifying diabetes mellitus and history of myocardial infarction as risk factors for postoperative infection within 30 days of surgery. Lateral malleolar repair was less likely to lead to infection, or need for repeated surgery, than was medial malleolar fracture repair. Diabetes mellitus, neuropathy, and chronic obstructive pulmonary disease were associated with development of postoperative cellulitis. Patients with a history of cerebrovascular accident were more likely to return to the emergency department or to have a pulmonary embolism. Male sex, presence of lupus, and increased age were associated with repeat surgery.
尽管踝关节骨折是由专门从事足踝外科手术的矫形外科医生和足病医生进行手术治疗的常见损伤，但术后可能会出现并发症，这常常给患者带来经济负担。随着美国医疗保健向基于价值的护理转变，成本降低主要集中在减少并发症和非计划护理上。我们使用了一个大型的现代保险索赔数据库，研究了踝关节骨折切开复位内固定术后并发症的模式，发现糖尿病和心肌梗死史是术后 30 天内感染的危险因素。与内侧踝骨折修复相比，外侧踝骨修复不太可能导致感染或需要再次手术。糖尿病、神经病变和慢性阻塞性肺疾病与术后蜂窝织炎的发展有关。有中风病史的患者更有可能返回急诊室或发生肺栓塞。男性、狼疮存在和年龄增长与再次手术有关。
