title: Predictors of Adverse Events for Ankle Fractures: An Analysis of 6800 Patients.
abstract: Ankle fractures are one of the most common injuries seen by orthopedic surgeons. It is therefore essential to understand the risks associated with their treatment. Using the American College of Surgeons National Surgical Quality Improvement Program(®) database from 2006 to 2013, the patient demographics, comorbidities, and 30-day complications were collected for 5 types of ankle fractures. A bivariate analysis was used to compare the patient demographics, comorbidities, and complications across all Common Procedural Terminology codes. A multivariable logistic regression model was then used to assess the odds of minor and major postoperative complications within 30 days after open treatment. A total of 6865 patients were included in the analysis. Of these patients, 2507 (36.5%) had bimalleolar ankle fractures. The overall rate of adverse events for ankle fractures was low. Bimalleolar fractures had the greatest rate of major (2.6%, n = 64), minor (3.8%, n = 94), and total (5.7%, n = 143) complications. When controlling for individual patient characteristics, bimalleolar fractures were associated with 4.92 times the odds (95% confidence interval 1.80 to 13.5; p = .002) of developing a complication compared with those with a medial malleolar fracture. The risk factors driving postoperative complications for all ankle fractures were age >65 years, obesity, diabetes, American Society of Anesthesiologists score >2, and functional status (p < .05). Although the overall rate of adverse events for ankle fractures was low, bimalleolar fractures were associated with 5 times the odds of developing a complication compared with medial malleolar fractures. Orthopedic surgeons must be aware of the risk factors that increase the rate of ankle fracture complications to improve patients' quality of care.
authors.affiliation: Research Analyst, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Ashley C
authors.initials: AC
authors.lastname: Dodd
authors.affiliation: Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Nikita
authors.initials: N
authors.lastname: Lakomkin
authors.affiliation: Research Assistant, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Basem
authors.initials: B
authors.lastname: Attum
authors.affiliation: Statistician, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Catherine
authors.initials: C
authors.lastname: Bulka
authors.affiliation: Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Aditya V
authors.initials: AV
authors.lastname: Karhade
authors.affiliation: Student, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Diana G
authors.initials: DG
authors.lastname: Douleh
authors.affiliation: Associate Professor, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: Hassan
authors.initials: H
authors.lastname: Mir
authors.affiliation: Assistant Professor, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: A Alex
authors.initials: AA
authors.lastname: Jahangir
authors.affiliation: Associate Professor, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN.
authors.forename: William T
authors.initials: WT
authors.lastname: Obremskey
authors.affiliation: Associate Professor, Vanderbilt Orthopaedic Institute Center for Health Policy, Vanderbilt University, Nashville, TN. Electronic address: Manish.Sethi@Vanderbilt.edu.
authors.forename: Manish K
authors.initials: MK
authors.lastname: Sethi
mesh_terms: D000367:Age Factors; D000368:Aged; D064386:Ankle Fractures / Q000601:surgery*; D016208:Databases, Factual; D048909:Diabetes Complications; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications; D012307:Risk Factors
keywords: ankle fractures; complications; open reduction and internal fixation; risk factors