title: [Surgical treatment of ankle fractures as an outpatient procedure. A safe and resource-efficient concept?].
abstract: BACKGROUND
  In many European countries, patients requiring surgical treatment of ankle fractures are generally hospitalized for an average of 8-11 days. This anecdotal concept is largely based on the premise that the inpatient monitoring of soft tissue conditions may lead to a decreased complication rate. The present study was designed to test the hypothesis that the surgical care of isolated ankle fractures as an outpatient procedure represents a safe and feasible concept which is not associated with an increased complication rate.
  
  
  METHODS
  A retrospective analysis was performed of a prospective database during a 5-year period (01/01/2005-12/31/2009) at a US academic level 1 trauma center with an institutional protocol of outpatient surgery for isolated ankle fractures. All fractures were classified according to the AO/OTA system. Outcome parameters consisted of the rate of postoperative complications and frequency of unplanned surgical revisions outpatient isolated versus inpatient isolated with surgical fixation of ankle isolated fractures.
  
  
  RESULTS
  Among 810 consecutive patients with ankle fractures during the study period, 476 met the inclusion criteria. Of these, 256 patients (53.8%) were treated as outpatients. The average length of stay of patients who were admitted as inpatients was 1.5±0.8 days (range 1-5 days). The age distribution was in a similar range for inpatients and outpatients (39±14.1 vs 35±12.8 years), and the injury severity based on the AO/OTA fracture classification revealed a similar distribution of fracture patterns in both groups. The rate of postoperative complications (9.1 vs 3.1%) and of unplanned surgical revisions (3.6 vs 1.2%) was significantly increased in the hospitalized group, compared to patients with ambulatory surgery (P<0.05).
  
  
  CONCLUSIONS
  The surgical treatment of isolated ankle fractures as an outpatient procedure represents a safe and resource-efficient concept which is not associated with an increased complication rate. Cultural differences in the domestic environment of individual patients may have to be taken into consideration.
authors.affiliation: Denver Health Medical Center, Department of Orthopaedic Surgery, University of Colorado  Denver, School of Medicine , 777 Bannock Street, 80204, Denver, USA.
authors.forename: S
authors.initials: S
authors.lastname: Weckbach
authors.forename: M A
authors.initials: MA
authors.lastname: Flierl
authors.forename: M
authors.initials: M
authors.lastname: Huber-Lang
authors.forename: F
authors.initials: F
authors.lastname: Gebhard
authors.forename: P F
authors.initials: PF
authors.lastname: Stahel
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000379:methods*; D016512:Ankle Injuries / Q000601:surgery*; D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D017598:Efficiency, Organizational; D005240:Feasibility Studies; D050723:Fractures, Bone / Q000601:surgery*; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D014193:Trauma Centers; D014481:United States