The Factors Associated with Prolonged Inpatient Stay after Surgical Fixation of Acute Ankle Fractures

Abstract 

In order to identify specific factors associated with prolonged inpatient stay following surgical correction of acute ankle fracture, we conducted a retrospective cohort study of patients who underwent acute ankle fracture repair, comparing length of hospital stay to the reason for delay of surgery (logistical versus clinical), type of fracture, and age. Our findings showed that delay in surgical repair beyond 24 hours following presentation to the emergency department was associated with a statistically significant overall longer length of stay, in comparison to patients who underwent surgery within the first 24 hours (P = .022). Delay due to clinical reasons statistically significantly increased the length of stay (P = .004), whereas those due to purely logistical reasons also prolonged the stay, although this association was not statistically significant in our study (P = .086). We also observed a statistically significant positive correlation between age and length of stay (P ≤ .001, Spearman's rho = 0.55). Interestingly, patients with a trimalleolar fracture showed a shorter length of stay if the repair was delayed, although this could not be shown to be statistically significant. The results of this investigation indicate that length of hospital stay following ankle fracture is increased by delaying surgical repair of the ankle greater than 24 hours from the time that the patient presents to the emergency department, as well as increased patient age.

Level of Clinical Evidence: 2

Keywords: delayed surgical repair, length of stay, surgery