Readmission within 30-days of open reduction and internal fixation for ankle fractures: NSQIP analysis of 29,905 patients

Background Historically, ankle fractures have been treated with open reduction and internal fixation (ORIF) procedures, which are considered safe and effective. Patient characteristics may contribute to postoperative difficulties thereby increasing risk of hospital readmission. The objective of this study was to determine the frequency of and reasons for 30-day readmission and postoperative complications following ORIF for ankle fractures. Methods A retrospective review of the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2021 identified patients undergoing ORIF for ankle fractures. Patient demographics, complication incidence, and reasons for unplanned hospital readmission were collected. Multivariable analyses identified patient risk factors for any adverse event (AAE) and readmission within 30-days of surgery. Results The 29,905 patients queried who underwent ORIF procedures for ankle fractures between 2015 and 2021 were 49.6 +/- 18.40 years of age, 30.9 +/- 7.10 kg/m(2), and 40.81% male. Of this cohort, 981 (3.30%) experienced 30-day postoperative adverse events, with surgical site infections (SSI; 1.25%) the most common. Unplanned readmission was observed in 2.08% of patients after a mean of 14.64 days. Surgical site related readmissions were 20.55% (n = 128) of reported readmissions with the most common being superficial incisional SSI. Notable risk factors for adverse events included ASA class (OR = 1.579, P < .001), COPD (OR = 1.522, P < .001), bleeding disorders (OR = 1.489, P = .001), diabetes (OR = 1.254, P = .008), and current smoking status (OR = 1.295, P = .002). Risk factors for readmission were ASA class (OR = 1.762, P < .001), COPD (OR = 1.599, P < .001), bleeding disorder (OR = 1.711, P < .001), diabetes (OR = 1.494, P < .001), end stage renal disease (OR = 3.304, P < .001), steroid use (OR = 2.144, P < .001), and current smoking status (OR = 1.667, P < .001). Conclusion Despite a low adverse event rate, 2% of patients required unplanned readmission after ORIF for ankle fractures. Surgical site complications account for almost half of reported readmissions. ASA class and various medical comorbidities were found to significantly increase the risk of postoperative adverse events and hospital readmission.