title: The costs of operative complications for ankle fractures: a case control study.
abstract: As our healthcare system moves towards bundling payments, it is vital to understand the potential financial implications associated with treatment of surgical complications. Considering that surgical treatment of ankle fractures is common, there remains minimal data relating costs to postsurgical intervention. We aimed to identify costs associated with ankle fracture complications through case-control analysis. Using retrospective analysis at a level I trauma center, 28 patients with isolated ankle fractures who developed complications (cases) were matched with 28 isolated ankle fracture patients without complications (controls) based on ASA score, age, surgery type, and fracture type. Patient charts were reviewed for demographics and complications leading to readmission/reoperation and costs were obtained from the financial department. Wilcoxon tests measured differences in the costs between the cases and controls. 28 out of 439 patients (6.4%) developed complications. Length of stay and median costs were significantly higher for cases than controls. Specifically, differences in total costs existed for infection and hardware-related pain. This is the first study to highlight the considerable costs associated with the treatment of complications due to isolated ankle fractures. Physicians must therefore emphasize methods to control surgical and nonsurgical factors that may impact postoperative complications, especially under a global payment system.
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Frank R
authors.initials: FR
authors.lastname: Avilucea
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Greenberg
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: W Jeffrey
authors.initials: WJ
authors.lastname: Grantham
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Vasanth
authors.initials: V
authors.lastname: Sathiyakumar
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Rachel V
authors.initials: RV
authors.lastname: Thakore
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Samuel K
authors.initials: SK
authors.lastname: Nwosu
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Hassan R
authors.initials: HR
authors.lastname: Mir
authors.affiliation: The Vanderbilt Orthopaedic Institute Center for Health Policy, 1215 21st Avenue S., MCE, South Tower, Suite 4200, Vanderbilt University, Nashville, TN 37232, USA.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi