title: Morbidity and Mortality Associated with Geriatric Ankle Fractures: A Medicare Part A Claims Database Analysis.
abstract: BACKGROUND
  The purpose of this study was to examine the incidence of adverse events in elderly patients who required inpatient admission after sustaining an ankle fracture and to consider these data in relation to geriatric hip fracture and other geriatric patient admissions.
  
  
  METHODS
  A retrospective cohort study of patients admitted with an ankle fracture, a hip fracture, or any other diagnosis was performed with the Medicare Part A database for 2008. The primary outcome measure was the one-year mortality rate, examined with multivariate analysis factoring for both patient age and preexisting comorbidity. Secondary outcome measures analyzed additional morbidity as reflected by length of stay, discharge disposition, readmissions, and medical complications.
  
  
  RESULTS
  There were 19,648 patients with ankle fractures, 193,980 patients with hip fractures, and 5,801,831 patients with other admitting diagnoses. Significant differences (p < 0.001) were noted in both age and comorbidity status between the group with ankle fractures and the group with hip fractures. The one-year mortality after admission was 11.9% for patients with ankle fracture, 28.2% for patients with hip fracture, and 21.5% for patients with any other admission. Upon using multivariate analysis to account for both age and comorbidity, the hazard ratio for one-year mortality associated with fracture was 1.088 for patients with hip fracture and 0.557 for patients with ankle fracture.
  
  
  CONCLUSIONS
  Even after selecting for admitted patients and accounting for both age and comorbidity, geriatric patients with ankle fractures were found to have a lower one-year morbidity compared with geriatric patients who had sustained a hip fracture or alternative admitting diagnoses. Geriatric patients with ankle fractures are likely healthier and more active in ways that are not captured by simply accounting for age and comorbidity. These findings may support more aggressive definitive management of such injuries in this population.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Brown University, Suite 200, 2 Dudley Street, Providence, RI 02903. E-mail address for R.Y. Hsu: Raymond_Hsu@brown.edu.
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Hsu
authors.affiliation: Center for Gerontology and Health Care Research, School of Public Health, Brown University, Box G-S121-6, 121 South Main Street, Providence, RI 02912.
authors.forename: Yoojin
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Brown University, Suite 200, 2 Dudley Street, Providence, RI 02903. E-mail address for R.Y. Hsu: Raymond_Hsu@brown.edu.
authors.forename: Roman
authors.initials: R
authors.lastname: Hayda
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: DiGiovanni
authors.affiliation: Center for Gerontology and Health Care Research, School of Public Health, Brown University, Box G-S121-6, 121 South Main Street, Providence, RI 02912.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.affiliation: Department of Orthopaedic Surgery, Emory University School of Medicine, 59 Executive Park South, Atlanta, GA 30329.
authors.forename: Jason T
authors.initials: JT
authors.lastname: Bariteau
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D016208:Databases, Factual; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D016344:Medicare Part A; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology