Ankle Fractures: Determining factors influencing time to surgery and the impact on hospital stay, costs and HRQOL

Abstract

Background: There remains controversy on ankle fracture management regarding standardised time of when to operate. The retrospective review of 509 patients who had surgical fixation of an ankle fracture were retrospectively reviewed from January 2013 to December 2015. Aim: The study established factors influencing time to surgery and the impact on length of stay (LOS), costs and health-related quality of life (HRQOL). Methods: Information extracted using Access Database and table views for inpatient procedures, diagnosis and PIMS Theatre was used to describe the population. Patients were divided into less than 24 hours and more than 24 hours surgery groups. Chi-square and fisher exact test were used to assess the associations between the risk factors and the primary outcome. Simple logistic regression determined factors that were significantly related to time of surgery. Multiple logistic regression accounted for patients’ characteristics such as age, gender and ethnicity as well as the risk factors. Microsoft excel produced scatter plots and line graphs for the descriptive summary of secondary outcomes. The SF- 12 survey was mailed out to 58 participants to elicit HRQOL. The responses were scored using the SF-12 scoring software. Findings: The population comprised 236 (46.37%) males, average age 37years (SD) 15 and 273 (53.63%) females, average age 45 years (SD 16). The time to surgery rates were compared across the following risk factors; type of fracture, type of surgery, causes and admission pathway. A total of 204 (40%) had surgery in less than (<) 24hours whilst 305 (60%) had surgery in more than (>) 24 hours. Average LOS was three and six days respectively. There was a strong correlation between LOS and costs. Simple unadjusted logistic regression results indicated that only age, type of fracture and admission pathway were significantly associated with time to surgery. The ankle fracture was found to have a large impact on the individual’s role physically, emotionally and on socially. Conclusion: Age, admission pathway, acuity and fracture type were found to significantly influence time to surgery. Descriptive results showed reduced LOS and costs with early surgery. Strategies that may enhance timely surgical management of ankle fractures such as renting private hospitals are recommended to minimise theatre delays. Keywords: Fractured malleolus, early/delayed surgery, length of stay/costs, health-related quality of life, quantitative research, impact