Trends in Urgent Care Utilization Following Ankle Fracture Fixation

2018 ◽  
Vol 40 (2) ◽  
pp. 218-223 ◽  
Author(s):  
Mostafa M. Abousayed ◽  
Christopher K. Johnson ◽  
Muhammad Moral ◽  
Sarah Sternbach ◽  
Andrew J. Rosenbaum
Keyword(s):  
Psychiatric Disorders ◽  
Healthcare System ◽  
Ankle Fracture ◽  
Univariate Analysis ◽  
Care Facility ◽  
Urgent Care ◽  
Care Utilization ◽  
Level Of Evidence ◽  
Patients With Diabetes ◽  
Fracture Surgery

Background: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients’ demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented. Results: Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03). Conclusion: In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system. Level of Evidence: Level III, comparative series.

scholarly journals Trends in Urgent Care Utilization Following Ankle Fracture Fixation

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0013
Author(s):  
Mostafa Abousayed ◽  
Christopher Johnson ◽  
Andrew Rosenbaum
Keyword(s):  
Psychiatric Disorders ◽  
Healthcare System ◽  
Ankle Fracture ◽  
Care Facility ◽  
Axial Skeleton ◽  
Urgent Care ◽  
Care Utilization ◽  
Post Discharge ◽  
Patients With Diabetes ◽  
Fracture Surgery

Category: Ankle Introduction/Purpose: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve post-discharge care and reduce unnecessary readmissions. Readmissions within 30-days are frequent and represent an economic burden on patients and the healthcare system alike. A recent study reported a 3.17% readmission rate after open reduction and internal fixation (ORIF) of ankle fractures. While readmission implies inpatient-discharge to inpatient-readmission, patients may present to urgent care facilities and receive medical treatment without being admitted. This too has socioeconomic implications. The incidence and reasons for urgent care visits following ankle fracture surgery has not been studied. The aim of this study is to evaluate the frequency and causes for urgent care visits within 30-days of discharge after ankle ORIF and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between 7/1/2016 and 6/30/2017 were included. Patients were identified using CPT codes for ankle ORIF ((27814, 27822, 27823, 27792, 27766, and 27829). Patients less than 18 years of age, with open fractures or with other appendicular or axial skeleton injuries were excluded. Patients’ demographics including age, sex, race, BMI, occupation, insurance payer and comorbidities were documented. The primary outcome of our study was to determine the frequency of urgent care visits within 30-days of discharge after ankle ORIF. Our secondary goals were to evaluate the association between urgent care visits and demographics, and identify the reason for post-operative urgent care utilization. Results: A total of 333 patients met the inclusion criteria. Fifty four percent of our cohort were males. Thirty five patients (10.51%) had urgent care visits with 30-days of discharge. Patients presented at a mean of 11.83 days from the day of surgery. Sixteen patients (45.71%) had cast/splint related issues, seven (20%) presented with pain and seven (20%) with increased surgical site drainage (Fig 1). Univariable analysis demonstrated a statistically significant association between post-operative urgent care utilization and patients with diabetes (p=0.03) and underlying psychiatric disorders (p=0.03). Conclusion: In this population study of patients undergoing ankle fracture surgery who underwent ankle ORIF, we found that the rate of urgent care visits within 30-days of discharge exceeds the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders are significantly more likely to present to an urgent care facility post-operatively. This is an important finding, as there are large costs to the healthcare system associated with this. Future studies must identify additional risk factors and means of reducing such added costs to our already stressed healthcare system.

Comparison of 2-Octyl Cyanoacrylate Topical Skin Adhesive and Simple Interrupted Nylon Sutures for Wound Closure in Ankle Fracture Surgery

2018 ◽  
Vol 39 (11) ◽  
pp. 1283-1289
Author(s):  
Young Hwan Park ◽  
Jong Hyub Song ◽  
Gi Won Choi ◽  
Hak Jun Kim
Keyword(s):  
Patient Satisfaction ◽  
Ankle Fracture ◽  
Statistical Power ◽  
Wound Closure ◽  
Operative Time ◽  
Wound Complications ◽  
Complication Rates ◽  
Level Of Evidence ◽  
Retrospective Comparative Study ◽  
Fracture Surgery

Background: Multiple options are available for closure of incisions in ankle fracture surgery. The aim of our study was to compare postoperative outcomes between conventional simple interrupted nylon sutures and 2-octyl cyanoacrylate as a topical skin adhesive to close the incision after ankle fracture surgery. Methods: We retrospectively reviewed the records of 367 consecutive patients (174 simple interrupted nylon suture patients and 193 topical skin adhesive patients) who underwent operative treatment for ankle fracture between 2010 and 2015. Development of wound complications, operative time, Olerud–Molander Ankle Score (OMAS), and patient satisfaction with the wound were compared. The demographics between the 2 groups were not different. Results: There were no differences in complication rates ( P = .861), OMAS at 3 months or 12 months following surgery ( P = .897 and .646, respectively) between the 2 types of wound closure. Operative time was 9 minutes shorter when topical skin adhesive was used compared to nylon sutures ( P = .003). Patient satisfaction with their wound was significantly higher in the topical skin adhesive group than the nylon skin suture group ( P = .012). Conclusions: The use of 2-octyl cyanoacrylate topical skin adhesive for wound closure following ankle fracture surgery was effective, safe, and showed higher patient satisfaction compared to simple interrupted nylon sutures. Although caution should be taken because of the insufficient statistical power of complications, this method was an additional safe option for wound closure in ankle fracture surgery. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Influence of ankle fracture surgery on glycemic control in patients with diabetes

2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Seung Yeol Lee ◽  
Moon Seok Park ◽  
Soon-Sun Kwon ◽  
Ki Hyuk Sung ◽  
Hyun Soo Jung ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Ankle Fracture ◽  
Patients With Diabetes ◽  
Fracture Surgery

scholarly journals Clinical Outcome of Bimalleolar Ankle Fracture in Patients with Diabetes Mellitus

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0032
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Diabetes Mellitus ◽  
Clinical Outcome ◽  
Internal Fixation ◽  
Ankle Fracture ◽  
Open Reduction ◽  
Outcome Analysis ◽  
Charcot Arthropathy ◽  
Union Rate ◽  
Patients With Diabetes ◽  
Fracture Surgery

Category: Trauma; Ankle Introduction/Purpose: Diabetes is a risk factor of postoperative complication for fracture surgery. The purpose of this study was to evaluate the clinical outcome of bimalleolar ankle fracture in patients with diabetes mellitus. Methods: Twenty two patients (an average age; 69.3 years, an average HbA1C; 7.6%) with bi-malleolar ankle Fracture received open reduction and internal fixation between March 2013 and January 2019. Complications related to surgery, progression to Charcot arthropathy, presence of nonunion were used for outcome analysis. The patients were followed for an average of 12.1 months. Results: The nonunion rate was 4.5% (1 case over 22 cases). The incidence rate of Charcot arthropathy was 4.5% (1 case over 22 cases). The patient with Charcot arthropathy was conversed to the tibiotalarcalcaneal fusion with retrograde intramedullary nail. No wound infection or soft tissue complications related to surgery was reported. Conclusion: Standard open reduction and internal fixation technique showed high union rate of bimalleolar ankle fracture in patients with diabetes mellitus. The surgeon should be cautious to the Charcot arthropathy when treating ankle fracture with diabetes mellitus.

Elevated Risks of Ankle Fracture Surgery in Patients With Diabetes

2010 ◽  
Vol 28 (4) ◽  
pp. 166-170 ◽  
Author(s):  
N. F. SooHoo ◽  
L. Krenek ◽  
M. Eagan ◽  
D. S. Zingmond
Keyword(s):  
Ankle Fracture ◽  
Patients With Diabetes ◽  
Fracture Surgery

scholarly journals Smoking is Associated with a Higher Risk of Unplanned Medical Visits among Adult Patients with Diabetes

2019 ◽  
Author(s):  
Arielle Selya ◽  
Eric L Johnson ◽  
Tess L Weber ◽  
Jaymi Russo ◽  
Cheryl Stansbury ◽  
...  
Keyword(s):  
Healthcare System ◽  
Smoking Status ◽  
Fold Increase ◽  
Emergency Department Visits ◽  
Urgent Care ◽  
Medical Visit ◽  
Old Patients ◽  
Medical Visits ◽  
Patients With Diabetes ◽  
Unplanned Visit

Abstract Background Smoking exacerbates the complications of diabetes, but little is known about whether patients with diabetes have more unplanned medical visits. This study examines the association between smoking status and unplanned medical visits among patients with diabetes. Methods Data were drawn from electronic medical records (EMR’s) from a large healthcare provider in the Northern Plains region of the US, from adult (≥18 years old) patients with type 1 or type 2 diabetes who received care within this healthcare system at least once during the 3-year period spanning 2014-16 (N=62,149). The association between smoking status (current, former, or never smoker) and having ≥1 unplanned visit (comprised of emergency department visits, hospitalizations, hospital observations, and urgent care) was examined after adjusting for age, race/ethnicity, and body mass index (BMI). The top ten most common diagnoses for unplanned visits were examined by smoking status. Results Both current and former smoking were associated with an approximately 1.2-fold increase in the odds of having at least one unplanned medical visit in the 3-year period (OR=1.22, 95% CI=1.16-129; OR=1.23, 95% CI=1.19-1.28, respectively), relative to never-smokers. Most common diagnoses for all patients were pain-related. However, diagnoses related to musculoskeletal system and connective tissue disorders were more common among smokers. Smoking is associated with a higher rate of unplanned medical visits among patients with diabetes in this regional healthcare system. Conclusions Results from this study reveal higher rates of unplanned visits among smokers and former smokers, as well as increased frequencies of unplanned medical visits among current smokers.

Preoperative Depression is Associated With Increased Complications Following Ankle Fracture Surgery

2022 ◽  
pp. 193864002110659
Author(s):  
Matthew S. Broggi ◽  
Syed Tahmid ◽  
John Hurt ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Pain Syndrome ◽  
International Classification Of Diseases ◽  
Emergency Department Visits ◽  
Wound Complications ◽  
Level Of Evidence ◽  
Chi Squared ◽  
Classification Of Diseases ◽  
Icd Codes ◽  
Fracture Surgery

Background The effects of preoperative depression following ankle fracture surgery remains unknown. The purpose of this study is to investigate the relationship between preoperative depression and outcomes following ankle fracture surgery. Methods This retrospective study used the Truven MarketScan database to identify patients who underwent ankle fracture surgery from January 2009 to December 2018. Patients with and without a diagnosis of preoperative depression were identified based on International Classification of Diseases (ICD) codes. Chi-squared and multivariate analyses were performed to determine the association between preoperative depression and postoperative complications following ankle fracture surgery. Results In total, 107,897 patients were identified for analysis, 13,981 of whom were diagnosed with depression (13%). Preoperative depression was associated with the increased odds for postoperative infection (odds ratio [OR]: 1.33, confidence interval [CI]: 1.20-1.46), wound complications (OR: 1.13, CI: 1.00-1.28), pain-related postoperative emergency department visits (OR: 1.58, CI: 1.30-19.1), 30-day and 90-day readmissions (OR: 1.08, CI: 1.03-1.21 and OR: 1.13, CI: 1.07-1.18), sepsis (OR: 1.39, CI: 1.12-1.72), and postoperative development of complex regional pain syndrome (OR: 1.46, CI: 1.18-1.81). Conclusion Preoperative depression is associated with increased complications following ankle fracture surgery. Further studies are warranted to investigate the degree to which depression is a modifiable risk factor. Level of Evidence: 3

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