Controversy exists regarding the risks and benefits of ankle fracture treatment in elderly patients. The purpose of this study was to use the United States Medicare database to determine the complication rate for ankle fractures in elderly patients treated operatively and to compare it to fractures treated nonoperatively.
We used the National Medicare Claims History System to study all enrollees who sustained ankle fractures between 1998 and 2001. A total of 33,704 patients were identified and their outcomes at numerous time points were evaluated. These outcomes included mortality, rate of repeat hospitalization, rate of medical and operative complications, and the rate of additional surgery. The predictor variables were either nonoperative or operative intervention. Covariates included patient age, gender, race, medical comorbidity status, and fracture type.
Patients treated nonoperatively had significantly higher mortality (p < 0.05) than those treated operatively at all time periods except for 30 days. However, patients treated operatively had significantly higher rehospitalization rates (p < 0.05) at all time periods studied. The medical and operative complication rates at all time periods were less than or equal to 2% for patients who had either operative or nonoperative treatment. In the group that had operative management, a relatively small number of patients had additional procedures. Eleven percent had removal of hardware. Less than 1% of all patients had revision of the internal fixation, arthroplasty, arthrodesis, or amputation.
In properly selected cases, the complication rates of both operatively and nonoperatively treated elderly patients are low.
"Multivariable analysis discovered several other variables associated with mortality. Patients who underwent operative fixation within one month exhibited a decrease mortality risk, which is in concordance with the current literature on management of geriatric ankle fractures . Patients readmitted to the hospital within 30 days of discharge were also at Fig. 1 "
[Show abstract][Hide abstract] ABSTRACT: Introduction:
The incidence of geriatric ankle fractures will undoubtedly increase as the population continues to grow. Many geriatric patients struggle to function independently after such injury and often require placement into nursing homes. The morbidity and mortality associated with nursing homes is well documented within the field of orthopaedic surgery. However, there is currently no study examining the mortality associated with nursing home placement following hospitalization for an ankle fracture. Therefore, the purpose of this study was to determine if geriatric patients admitted to nursing homes following an ankle fracture experience elevated mortality rates.
Patients were identified using diagnosis codes for ankle fractures from all 2008 part A Medicare claims, and those admitted to nursing homes were identified using a Minimum Data Set (MDS). The Medicare database was also analyzed for specific variables including over-all one year mortality, length of stay, age distribution, certain demographical characteristics, incidence of medical and surgical complications within 90 days, and the presence of comorbidities. Multivariate logistic regression analysis was used to determine if patients admitted to nursing homes had elevated mortality rates.
19,648 patients with ankle fractures were identified, and 11,625 (59.0%) of these patients went to a nursing home after hospitalization. Patients who went to a nursing home had higher Elixhauser and Deyo-Charlson comorbidity scores (p<0.0001). Nursing home patients also had significantly increased rates of postoperative medical and surgical complications. One year mortality was 6.9% for patients who did not go to a nursing home and 15.4% for patients who were admitted to a nursing home (p<0.0001). However, multivariate logistic regression analysis demonstrated no significant difference in one year mortality between patients admitted to nursing homes and those who were not (OR=1.1; 95% CI 0.99-1.24, p>0.05).
Although admission to nursing home was significantly associated with increased mortality in a bivariate statistical model, this significance was lost during multivariate analysis. This suggests that other patient characteristics may play a more prominent role in determining one year mortality following geriatric ankle fractures.
"Geriatric patients provide unique challenges in fracture management due to their bone quality and medical comorbidities (Little et al. 2013). SSI is a strong predictor of mortality in elderly patients (Lee et al. 2006), and controversies remain regarding the risks and benefits of operative treatment in geriatric patients (Koval et al. 2007, Strauss and Egol 2007, Hak et al. 2011, Shivarathre et al. 2011, Lynde et al. 2012, Little et al. 2013, McKean et al. 2013, Olsen et al. 2013, Zaghloul et al. 2014). The risks of surgical treatment should be carefully evaluated in all elderly patients (Kettunen and Kröger 2005). "
"This is of importance, since the elderly population have poorer health preoperatively (based on the number of comorbidities) and have higher perioperative complication rates compared to younger patients (Anderson et al. 2008). It is also known that bi-and tri-malleolar fractures have a higher mortality rate than uni-malleolar fractures (Koval et al. 2007). These fractures are a challenge, both surgically and concerning perioperative care. "
[Show abstract][Hide abstract] ABSTRACT: Previous national epidemiological data on the characteristics and trends of patients with ankle fractures have been limited. We therefore analyzed data on Swedish inpatients with ankle fractures in this nationwide population study, based on data from 1987 through 2004.
Data on all inpatients aged 15 years and older with ankle fracture were extracted from the Swedish National Patient Register for the period 1987-2004.
We identified 91,410 hospital admissions with ankle fracture, corresponding to an annual incidence rate of 71 per 10(5) person-years. During the study period, the number of hospital admissions increased by 0.2% annually, mainly from increase in fracture incidence in the elderly women. Mean age at admission was 45 (SD 19) years for men and 58 (18) for women. The major mechanism of injury was falling at the same level (64%).
This nationwide study of inpatients with ankle fractures showed an increase in fracture incidence, particularly in elderly women.
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