title: Associations of timing of surgery with postoperative length of stay, complications, and functional outcomes 3-6 years after operative fixation of closed ankle fractures.
abstract: OBJECTIVE
  To evaluate the associations of timing of surgery with postoperative length of stay (LOS), complications, and functional outcomes 3-6 years after open reduction and internal fixation (ORIF) in closed ankle fractures.
  
  
  METHODS
  Historical cohort study by chart review of 1011 patients for postoperative LOS and complications; 959 individuals were invited to participate in a postal survey with functional outcomes questionnaires. Complications were classified as perioperative, early, or late. The associations with time from trauma to surgery (<8h, 8h to 6days, >6days) were assessed with (1) postoperative LOS using multivariable random-effects negative binomial regression, (2) complications using multivariable binary and multinomial logistic regression, and (3) three different functional outcomes using multivariable linear regression.
  
  
  RESULTS
  The mean patient age was 51.4 (range 18-94) years, 556 (55%) were female, and 567 individuals (59%) responded to the questionnaire. There were no statistically significant associations between time to surgery and either postoperative LOS or complications after adjusting for several patient and fracture characteristics. Patients operated on >6days after the trauma had significantly worse scores on the Olerud and Molander Ankle Score (OMAS) (p=0.039) and somewhat worse, but non-significant, scores on the Lower Extremity Functional Scale (LEFS; p=0.573) and the Self-Reported Foot and Ankle Score (SEFAS) scale (p=0.161) than those operated on <8h after trauma.
  
  
  CONCLUSIONS
  In ankle-fracture surgery, there was no apparent association between timing of surgery and postoperative LOS or complications. A delay of surgery for 8h to 6days resulted in similar functional outcomes after 3-6 years suggesting there may be a safe window of time for surgery of up to 6days after trauma that can be used to plan and perform the final ORIF.
authors.affiliation: Department of Orthopaedics, Østfold Hospital, Norway. Electronic address: markus.naumann@so-hf.no.
authors.forename: M G
authors.initials: MG
authors.lastname: Naumann
authors.affiliation: Department of Orthopaedics, Akershus University Hospital, Norway.
authors.forename: U
authors.initials: U
authors.lastname: Sigurdsen
authors.affiliation: Department of Orthopaedics, Akershus University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: S E
authors.initials: SE
authors.lastname: Utvåg
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Norway; Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Norway; Health Services Research Unit, Akershus University Hospital, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Stavem
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064386:Ankle Fractures / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D005596:Fractures, Closed / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D019538:Health Care Surveys; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009664:Norway; D011183:Postoperative Complications / Q000503:physiopathology*; D011184:Postoperative Period; D020127:Recovery of Function; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Closed ankle fracture; Complications; Functional outcome; Hospital stay; ORIF; Open reduction and internal fixation; Postoperative length of stay; Questionnaire; Timing of surgery