Outpatient orthopaedic trauma surgery: is it safe?

BACKGROUND

This study describes outcomes after outpatient operative fracture management concurrently with implementation of the 2019 Orthopaedic Trauma Association Guidelines for Musculoskeletal Pain. Primary and revision orthopaedic trauma cases were both completed, with standard comprehensive pain management regimen modeled on OTA/AO guidelines. For each procedure, the senior surgeon was assisted by the same anesthesia team. Regional anesthesia was determined by the surgeon and the anesthesiologist.

METHODS

This was a retrospective case series of 88 patients older than 18 years undergoing surgery for fractures and complications at an outpatient facility associated with a Level 1 trauma center.

RESULTS

The primary outcome measures were complications, emergency department visits, and reoperations. Secondary outcomes included office calls, pain control complaints, and medication refills. All data were captured by retrospective chart review. Of the 88 study patients, 52% were male and the median age was 41 years. Seventy-seven percent (68/88) received regional anesthesia at the time of surgery. A total of 7 patients (8%, 10 encounters) presented to the emergency department within 30 days. 60% of these encounters (6/10) were related to their injury. Four patients presented for pain, but none were admitted. Most (76%) of the office calls for pain were secondary to medication refill in accordance with the guidelines.

CONCLUSIONS

Patients can be cared for within the outpatient setting for many complex orthopaedic trauma conditions. Appropriate patient selection, utilization of regional anesthesia in selected patients, and proper pain management are necessary to ensure safety and comfort.

LEVEL OF EVIDENCE

Level III.