Ninety-Day Emergency Department Visits After Ankle Fracture Surgery

• Published in: Journal of the American Academy of Orthopaedic Surgeons Vol. 31; no. 1; pp. e51 - e57
• Main Authors: Kammien, Alexander J., Ratnasamy, Philip P., Joo, Peter Y., Grauer, Jonathan N.
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-01-2023
• Subjects: Adolescent; Ankle; Ankle Fractures - surgery; Emergency Service, Hospital; Humans; Medicaid; Postoperative Complications - epidemiology; Retrospective Studies; United States - epidemiology; United States
• ISSN: 1067-151X; 1940-5480
• DOI: 10.5435/JAAOS-D-22-00484

Emergency department (ED) visits after orthopaedic procedures such as ankle fracture open reduction and internal fixation (ORIF) have received less attention than other outcomes. This study analyzed 90-day ED visits after ankle fracture surgery in a national database to better characterize the incidence, timing, risk factors, and reasons.
Ankle fractures undergoing ORIF were extracted from the PearlDiver M91Ortho 2010 to 2020Q3 data set. Patients were excluded for age younger than 18 years, presence of concomitant fractures, and <90 days of database follow-up. Patient age, sex, Elixhauser Comorbidity Index score, region of the country, and insurance plan were analyzed as predictors for 90-day ED utilization using multivariate logistic regression. Incidence of readmissions and incidence, timing, risk factors, and reasons for ED visits were determined.
Of 87,662 ankle fracture ORIF patients identified, ED visits were noted within 90 days of surgery for 10,087 (11.5%) while 4,030 (4.6%) were readmitted. One ED visit was noted for 6,102 patients, two visits for 2,654, three visits for 787, and more than three visits for 544. The greatest weekly incidence of ED visits was observed in weeks 1 and 2, with 2.9% and 3.1% of the entire cohort visiting in each week respectively. Factors independently associated with 90-day ED utilization included younger age (odds ratio [OR] 1.21 per decade decrease, P < 0.001), greater Elixhauser Comorbidity Index score (OR 1.40 per two-point increase, P < 0.001), and Medicaid insurance (OR 1.92, P < 0.001). In the first two postoperative weeks, 71% of ED visits were attributed to issues directly involving the surgical site while in subsequent weeks, most visits did not involve the surgical site (65%).
Many patients visit the ED after ankle fracture surgery. The greatest ED utilization was during the first two postoperative weeks, and reasons for visits were defined. These findings have implications for optimizing care pathways and targeting resource allocation.