SLR - December 2016 - Huy Nguyen

Safety and Outcomes of Inpatient Compared with Outpatient Surgical Procedures for Ankle Fractures

Reference: Qin C, Dekker R, Blough JT, Kadakia AR. Safety and Outcomes of Inpatient Compared with Outpatient Surgical Procedures for Ankle Fractures. J Bone Joint Surg Am. 2016 Oct 19;98:1699–705

Scientific Literature Review

Reviewed By: Huy Nguyen, DPM
Residency Program: Montefiore Medical Center

Podiatric Relevance: Ankle fractures represent more than half of all fractures of the foot and ankle. Perioperative hospital admission for surgery is a common practice that has significant financial implications. With the cost of healthcare rising, it is important to minimize unnecessary hospitalization where possible. Recently, more effort has been put forth to assess the safety of outpatient surgical procedures in various fields, including orthopedic spine and total joint procedures. However, there is less similar literature in foot and ankle surgery. In this retrospective cohort study, the authors aim to support their hypothesis that ankle ORIF performed in the outpatient setting is as safe as ORIF performed in the inpatient setting.

Methods: The authors selected their cohorts from the American College of Surgeons-National Surgical Quality Improvement Project database to compare perioperative outcomes for outpatient vs. inpatient procedures. Patients undergoing ankle ORIF from 2005 to 2013 were selected. Emergent or infectious cases were excluded. All patients were propensity score-matched to reduce difference in baseline characteristics. Primary tracked outcomes included surgical and medical complications, unplanned readmissions and unplanned reoperations within 30 days of the procedure.

Results: A total of 3,732 patients met inclusion criteria, of whom 1,866 were designated as inpatient cases and 1,866 were designated as outpatient cases. The average age of the inpatient group was 51.0 years, and the average age of the outpatient group was 49.0 years. Outpatient surgeries were associated with lower rates of urinary tract infection, pneumonia, venous thromboembolic events and bleeding requiring transfusion. However, only the lower rate of pneumonia was statistically significant. Subanalysis of elderly patients (age 65+) showed higher rates of non-homebound discharges for inpatient surgeries. Overall, outpatient cases were associated with reduced 30-day medical morbidity. There was no significant difference in terms of surgical complications, unplanned reoperations and unplanned readmissions between the two groups.

Conclusions: The authors concluded that performing ORIF of ankle fractures in the outpatient setting is just as safe as in the inpatient setting for patients without major comorbidities. Avoiding admission can spare the patient from various complications associated with hospitalization, such as pneumonia and greatly reduce healthcare costs. The authors acknowledge limitations in their data collection methods and suggest that a prospective study may better elucidate the differences in safety between outpatient and inpatient ORIF.

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