Complications after ankle fracture in elderly patients.
BACKGROUND
Controversy exists regarding the risks and benefits of ankle fracture treatment in elderly patients. The purpose of this study was to use the United States Medicare database to determine the complication rate for ankle fractures in elderly patients treated operatively and to compare it to fractures treated nonoperatively.


METHODS
We used the National Medicare Claims History System to study all enrollees who sustained ankle fractures between 1998 and 2001. A total of 33,704 patients were identified and their outcomes at numerous time points were evaluated. These outcomes included mortality, rate of repeat hospitalization, rate of medical and operative complications, and the rate of additional surgery. The predictor variables were either nonoperative or operative intervention. Covariates included patient age, gender, race, medical comorbidity status, and fracture type.


RESULTS
Patients treated nonoperatively had significantly higher mortality (p < 0.05) than those treated operatively at all time periods except for 30 days. However, patients treated operatively had significantly higher rehospitalization rates (p < 0.05) at all time periods studied. The medical and operative complication rates at all time periods were less than or equal to 2% for patients who had either operative or nonoperative treatment. In the group that had operative management, a relatively small number of patients had additional procedures. Eleven percent had removal of hardware. Less than 1% of all patients had revision of the internal fixation, arthroplasty, arthrodesis, or amputation.


CONCLUSIONS
In properly selected cases, the complication rates of both operatively and nonoperatively treated elderly patients are low.
Koval
Kenneth J
KJ
Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA. kjkmd@yahoo.com
Zhou
Weiping
W
Sparks
Michael J
MJ
Cantu
Robert V
RV
Hecht
Paul
P
Lurie
Jon
J
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000706:statistics & numerical data; D016512:Ankle Injuries / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D001174:Arthrodesis / Q000706:statistics & numerical data; D001178:Arthroplasty / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D005593:Fracture Fixation, Internal / Q000706:statistics & numerical data; D050723:Fractures, Bone / Q000150:complications / Q000453:epidemiology* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data