Elevated Risks of Ankle Fracture Surgery in Patients With Diabetes

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.

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Trends in Urgent Care Utilization Following Ankle Fracture Fixation

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00136 ◽

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.

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

BMC Musculoskeletal Disorders ◽

10.1186/s12891-016-0987-x ◽

2016 ◽

Vol 17 (1) ◽

Cited By ~ 4

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

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Clinical Outcome of Bimalleolar Ankle Fracture in Patients with Diabetes Mellitus

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00320 ◽

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.

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Insulin Dependence Increases the Risk of 30-Day Postoperative Complications Following Ankle Fracture Surgery in Patients with Diabetes Mellitus

The Journal of Foot & Ankle Surgery ◽

10.1053/j.jfas.2021.03.011 ◽

2021 ◽

Author(s):

Jennifer W. Liu ◽

Junho Ahn ◽

Paul A. Nakonezny ◽

Trapper Lalli ◽

Michael D. VanPelt ◽

...

Keyword(s):

Diabetes Mellitus ◽

Postoperative Complications ◽

Ankle Fracture ◽

Insulin Dependence ◽

Patients With Diabetes ◽

Fracture Surgery

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Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients

Foot & Ankle Specialist ◽

10.1177/1938640021992922 ◽

2021 ◽

pp. 193864002199292

Author(s):

Hope Skibicki ◽

Sundeep Saini ◽

Ryan Rogero ◽

Kristen Nicholson ◽

Rachel J. Shakked ◽

...

Keyword(s):

Ankle Fracture ◽

Monitoring Program ◽

Opioid Consumption ◽

Consumption Patterns ◽

Utilization Rate ◽

Opioid Use ◽

Index Procedure ◽

Postoperative Visit ◽

Fracture Surgery

Introduction Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Methods Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients’ first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. Results At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Conclusion Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level of Evidence: Level III

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Association Between Opioid Use and Diabetes in Patients With Ankle Fracture Repair

Foot & Ankle International ◽

10.1177/10711007211058157 ◽

2021 ◽

pp. 107110072110581

Author(s):

Wenye Song ◽

Naohiro Shibuya ◽

Daniel C. Jupiter

Keyword(s):

Diabetes Mellitus ◽

Logistic Regression ◽

Ankle Fracture ◽

Regression Models ◽

Fracture Repair ◽

Opioid Use ◽

Data Set ◽

Opioid Prescription ◽

Logistic Regression Models ◽

Patients With Diabetes

Background: Ankle fractures in patients with diabetes mellitus have long been recognized as a challenge to practicing clinicians. Ankle fracture patients with diabetes may experience prolonged healing, higher risk of hardware failure, an increased risk of wound dehiscence and infection, and higher pain scores pre- and postoperatively, compared to patients without diabetes. However, the duration of opioid use among this patient cohort has not been previously evaluated. The purpose of this study is to retrospectively compare the time span of opioid utilization between ankle fracture patients with and without diabetes mellitus. Methods: We conducted a retrospective cohort study using our institution’s TriNetX database. A total of 640 ankle fracture patients were included in the analysis, of whom 73 had diabetes. All dates of opioid use for each patient were extracted from the data set, including the first and last date of opioid prescription. Descriptive analysis and logistic regression models were employed to explore the differences in opioid use between patients with and without diabetes after ankle fracture repair. A 2-tailed P value of .05 was set as the threshold for statistical significance. Results: Logistic regression models revealed that patients with diabetes are less likely to stop using opioids within 90 days, or within 180 days, after repair compared to patients without diabetes. Female sex, neuropathy, and prefracture opioid use are also associated with prolonged opioid use after ankle fracture repair. Conclusion: In our study cohort, ankle fracture patients with diabetes were more likely to require prolonged opioid use after fracture repair. Level of Evidence: Level III, prognostic.

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Wound-Healing Issues Following Rotational Ankle Fracture Surgery: Predictors and Local Management Options

Foot & Ankle Specialist ◽

10.1177/1938640018810422 ◽

2018 ◽

Vol 12 (5) ◽

pp. 409-417 ◽

Cited By ~ 1

Author(s):

Hesham Saleh ◽

Sanjit Konda ◽

Adam Driesman ◽

John Stranix ◽

Catherine Ly ◽

...

Keyword(s):

Wound Healing ◽

Ankle Fracture ◽

Wound Complications ◽

Management Options ◽

Original Cohort ◽

Surgical Interventions ◽

Postoperative Wound ◽

Trimalleolar Fractures ◽

Medical Histories ◽

Fracture Surgery

Background. The incidence and risk factors of wound-healing complications following rotational ankle fracture surgery are well documented in the literature. However, there is a paucity regarding management options following these complications. The goal of this study was to provide a descriptive analysis of one surgeon’s experience managing wound complications in patients who have undergone ankle fracture surgery. Methods. A total of 215 patients who were operatively treated for an unstable ankle were retrospectively identified. Patient demographics, medical histories, initial injury characteristics, surgical interventions, and clinical follow-up were collected. Twenty-five of these patients developed postoperative wound problems. Results. Of the original cohort of 215 patients, 25 (11.6%) developed wound-healing complications. Their average age was 53.6 ± 18.0 years; there were 12 males (48.0%). Connective tissue/inflammatory disease (odds ratio [OR] 3.9), cardiovascular disease (OR 3.6), and active smoking (OR 3.3) were associated with an increased likelihood of developing postoperative wound complications. With regard to injuries, open fractures (OR 17.9) had the highest likelihood of developing postoperative complications, followed by type 44-C (OR 2.8) and trimalleolar fractures (OR 2.0). Conclusion. Wound complications following open treatment of ankle fractures occurred with an incidence of 11.6% in this series, of which only about half required operative intervention. A third of wounds were managed by orthopaedics in conjunction with plastic surgery. Levels of Evidence: Level III: Retrospective comparative study

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Unrecognized Anterior Compartment Syndrome Following Ankle Fracture Surgery

Journal of the American Podiatric Medical Association ◽

10.7547/0990438 ◽

2009 ◽

Vol 99 (5) ◽

pp. 438-442 ◽

Cited By ~ 2

Author(s):

Aksel Seyahi ◽

Serkan Uludag ◽

Senol Akman ◽

Mehmet Demirhan

Keyword(s):

Compartment Syndrome ◽

Ankle Fracture ◽

Open Reduction ◽

Malleolar Fracture ◽

Anterior Compartment ◽

Exercise Induced ◽

Patient’S History ◽

Fracture Surgery ◽

Compartmental Pressure ◽

Suspected Diagnosis

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient’s history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity. (J Am Podiatr Med Assoc 99(5): 438–442, 2009)

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