Outpatient surgery in patients with ankle fractures minimises hospital admissions and utilisation of healthcare resources

Abstract

Purpose The recent outbreak of the novel coronavirus (SARS-CoV-2) has emphasised the need to minimise hospital admissions and utilisation of healthcare resources. The purpose of this study was to examine the outcomes of an outpatient surgery protocol for acute closed ankle fractures. Methods In this retrospective study, 262 patients underwent outpatient surgery for their closed ankle fractures at our level-1 trauma centre. A total of 196 patients met our inclusion criteria and were ultimately included in the final analysis. Our primary outcomes' measures included post-operative admission to the emergency department within 30 days after surgery and unplanned hospital readmission within 30 days after surgery. Our secondary outcome measure included the incidence of surgical site infection (SSI) within 12 weeks after surgery. Results Thirty-two patients (16.3%) had an unplanned emergency department visit within 30 days of fracture fixation and two patients (1.0%) required hospital readmission within 30 days of their surgery. Sixteen patients (8.2%) developed SSI, which included 11 (5.6%) superficial and five (2.6%) deep infections. Conclusion Strategic outpatient management of acute closed ankle fractures is associated with acceptable rates of unplanned emergency department visits, hospital readmissions, and SSIs. In the context of the recent SARS-CoV-2 outbreak, outpatient management of these injuries may aide in the mitigation of nosocomial infections and the preservation of finite healthcare resources.

SICOT PIONEER (Programme of Innovative Orthopaedic Networking Education and Research): Re-inventing global orthopaedic education, training and research

“…Since the evolution of the pandemic, reduced number of clinical cases have been observed in the orthopaedic outpatient departments (OPDs) along with the cancellations of elective surgeries resulting in lesser orthopaedic patient admission to hospitals [ 1 , 4 ]. Moreover, the task forces employed to manage the pandemic in various countries called for a delay or cancellation of all non-essential or elective surgeries.…”

“…Moreover, the task forces employed to manage the pandemic in various countries called for a delay or cancellation of all non-essential or elective surgeries. These decisions were taken to conserve healthcare resources (e.g., PPE, gloves, intensive care unit (ICU) beds, ventilators), reduce the risk of contagion transmission, reduce hospital admissions and enhance the capacity to support patients with COVID-19 [ 4 , 5 ]. Furthermore, one of the early studies conducted after the COVID-19 restrictions revealed a 32% reduction in trauma cases due to people remaining indoors during this period [ 6 ].…”

Emergency Department Visits Within 90 Days of Total Ankle Replacement

“…Studies have examined ED visits following elective foot and ankle procedures and open reduction and internal fixation (ORIF) for treatment of ankle fracture. 2 , 31 , 39 These studies report that postoperative ED visits are common, with 30-day incidences ranging from 7% to 22%. However, cohort sizes have been limited to less than 600 patients.…”

Ninety-Day Emergency Department Visits After Ankle Fracture Surgery

“…ED visits are reportedly common after elective foot and ankle surgery, with incidences ranging from 7% to 22%. [9][10][11] These studies, however, used single-institution cohorts with fewer than 600 patients evaluated within a 30-day postoperative period. Larger, nationwide studies are important for examining trends in postoperative ED utilization across the country.…”