Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
, Richmond, VA, USA.
J Orthop Surg Res. 2024 Sep 18;19(1):576. doi: 10.1186/s13018-024-04895-6.
Historically, ankle fractures have been treated with open reduction and internal fixation (ORIF) procedures, which are considered safe and effective. Patient characteristics may contribute to postoperative difficulties thereby increasing risk of hospital readmission. The objective of this study was to determine the frequency of and reasons for 30-day readmission and postoperative complications following ORIF for ankle fractures.
A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2021 identified patients undergoing ORIF for ankle fractures. Patient demographics, complication incidence, and reasons for unplanned hospital readmission were collected. Multivariable analyses identified patient risk factors for any adverse event (AAE) and readmission within 30-days of surgery.
The 29,905 patients queried who underwent ORIF procedures for ankle fractures between 2015 and 2021 were 49.6 ± 18.40 years of age, 30.9 ± 7.10 kg/m, and 40.81% male. Of this cohort, 981 (3.30%) experienced 30-day postoperative adverse events, with surgical site infections (SSI; 1.25%) the most common. Unplanned readmission was observed in 2.08% of patients after a mean of 14.64 days. Surgical site related readmissions were 20.55% (n = 128) of reported readmissions with the most common being superficial incisional SSI. Notable risk factors for adverse events included ASA class (OR = 1.579, P < .001), COPD (OR = 1.522, P < .001), bleeding disorders (OR = 1.489, P = .001), diabetes (OR = 1.254, P = .008), and current smoking status (OR = 1.295, P = .002). Risk factors for readmission were ASA class (OR = 1.762, P < .001), COPD (OR = 1.599, P < .001), bleeding disorder (OR = 1.711, P < .001), diabetes (OR = 1.494, P < .001), end stage renal disease (OR = 3.304, P < .001), steroid use (OR = 2.144, P < .001), and current smoking status (OR = 1.667, P < .001).
Despite a low adverse event rate, 2% of patients required unplanned readmission after ORIF for ankle fractures. Surgical site complications account for almost half of reported readmissions. ASA class and various medical comorbidities were found to significantly increase the risk of postoperative adverse events and hospital readmission.
从历史上看，踝关节骨折采用切开复位内固定（ORIF）手术治疗，该手术被认为是安全有效的。患者特征可能会导致术后出现困难，从而增加再次入院的风险。本研究旨在确定 ORIF 治疗踝关节骨折后 30 天内再入院和术后并发症的频率和原因。
回顾性分析 2015 年至 2021 年国家手术质量改进计划（NSQIP）数据库，确定接受 ORIF 治疗踝关节骨折的患者。收集患者人口统计学、并发症发生率以及非计划性住院再入院的原因。多变量分析确定了患者发生任何不良事件（AAE）和术后 30 天内再入院的风险因素。
2015 年至 2021 年间，对 29905 例接受 ORIF 手术治疗的踝关节骨折患者进行了查询，患者的平均年龄为 49.6±18.40 岁，平均体重指数为 30.9±7.10kg/m，男性占 40.81%。在这一队列中，981 例（3.30%）在术后 30 天内发生了不良事件，其中手术部位感染（SSI；1.25%）最为常见。在平均 14.64 天后，有 2.08%的患者发生了非计划性再入院。报告的再入院中有 20.55%（n=128）与手术部位相关，最常见的是浅表切口 SSI。不良事件的显著风险因素包括 ASA 分级（OR=1.579，P<0.001）、COPD（OR=1.522，P<0.001）、出血性疾病（OR=1.489，P=0.001）、糖尿病（OR=1.254，P=0.008）和当前吸烟状况（OR=1.295，P=0.002）。再入院的风险因素包括 ASA 分级（OR=1.762，P<0.001）、COPD（OR=1.599，P<0.001）、出血性疾病（OR=1.711，P<0.001）、糖尿病（OR=1.494，P<0.001）、终末期肾病（OR=3.304，P<0.001）、类固醇使用（OR=2.144，P<0.001）和当前吸烟状况（OR=1.667，P<0.001）。
尽管不良事件发生率较低，但仍有 2%的患者在接受 ORIF 治疗踝关节骨折后需要非计划性再入院。手术部位并发症占报告再入院的近一半。ASA 分级和各种合并症被发现显著增加了术后不良事件和住院再入院的风险。
