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European Journal of Trauma and Emergency Surgery

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Open Access 15-02-2023 | Ankle Fracture | Original Article

Does the type of anesthesia (regional vs. general) represent an independent predictor for in-hospital complications in operatively treated malleolar fractures? A retrospective analysis of 5262 patients

Authors: Claudio Canal, Alexander Kaserer, Laurent Sébastien Morax, Franziska Ziegenhain, Hans-Christoph Pape, Valentin Neuhaus

Published in: European Journal of Trauma and Emergency Surgery | Issue 3/2023

Abstract

Purpose

The impact of the type of anesthesia (regional vs. general anesthesia) on in-hospital complications in ankle fractures has not been thoroughly studied yet. Identifying factors that place patients at risk for complications following ankle fractures may help reduce their occurrence. The primary goal of this study was (1) to describe the cohort of patients and (2) to evaluate independent risk factors for complications during hospitalization.

Methods

We analyzed patients from 2005 to 2019 with an operatively treated isolated fracture of the medial or lateral malleolus using a prospective national quality measurement database. Patients were selected based on international classifications (ICD) and national procedural codes (CHOP). Uni- and multivariate analysis were applied.

Results

In total, we analyzed 5262 patients who suffered a fracture of the malleolus; 3003 patients (57%) had regional and 2259 (43%) general anesthesia. Patients with regional anesthesia were significantly older (51 vs. 46 years), but healthier (23 vs. 28% comorbidities) than patients who received general anesthesia. The in-hospital complication rate was not significantly lower in regional anesthesia (2.2% vs 3.0%). The type of anesthesia was not an independent predictor for complications while controlling for confounders.

Conclusion

Type of anesthesia was not an independent predictor of complications; however, higher ASA class, age over 70 years, fracture of the medial versus lateral malleolus, longer preoperative stay, and duration of surgery were significant predictors of complications. Patient and procedure characteristics, as well as changes in medical care and epidemiological changes along with patient requests, influenced the choice of the type of anesthesia.

Jennison T, Brinsden M. Fracture admission trends in England over a ten-year period. Ann R Coll Surg Engl. 2019;101(3):208–14. https://doi.org/10.1308/rcsann.2019.0002 (Epub 2019/01/31, PubMed PMID: 30698459; PubMed Central PMCID: PMCPMC6400910).CrossRefPubMedPubMedCentral

Beerekamp MSH, de Muinck Keizer RJO, Schep NWL, Ubbink DT, Panneman MJM, Goslings JC. Epidemiology of extremity fractures in the Netherlands. Injury. 2017;48(7):1355–62. https://doi.org/10.1016/j.injury.2017.04.047 (Epub 2017/05/11, PubMed PMID: 28487101).CrossRefPubMed

Silva ARB, Martinez LC, Pinheiro MM, Szejnfeld VL. Low-trauma ankle fractures in Brazil: secular trends in patients over 50 years old from 2004 to 2013. Arch Osteoporos. 2020;15(1):105. https://doi.org/10.1007/s11657-020-00777-6 (Epub 2020/07/24, PubMed PMID: 32700025).CrossRefPubMed

Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg. 2018;24(1):34–9. https://doi.org/10.1016/j.fas.2016.11.002 (Epub 2018/02/08, PubMed PMID: 29413771).CrossRefPubMed

Pflüger P, Wurm M, Biberthaler P, Pförringer D, Crönlein M. Analysis of 6851 foot and ankle injuries from 2010–2017 in an emergency department. Unfallchirurg. 2021. https://doi.org/10.1007/s00113-021-01081-9 (Epub 2021/10/01, PubMed PMID: 34591136).CrossRefPubMedPubMedCentral

Thur CK, Edgren G, Jansson K, Wretenberg P. Epidemiology of adult ankle fractures in Sweden between 1987 and 2004: a population-based study of 91,410 Swedish inpatients. Acta Orthop. 2012;83(3):276–81. https://doi.org/10.3109/17453674.2012.672091 (Epub 2012/03/10, PubMed PMID: 22401675; PubMed Central PMCID: PMCPMC3369155).CrossRefPubMedPubMedCentral

Contino V, Abrams JH, Arumugam S, Sinha SK, Vellanky SS, Cremins MS, et al. Spinal anesthesia using ropivacaine leads to earlier ambulation after total hip arthroplasty. Orthopedics. 2021;44(3):e343–6. https://doi.org/10.3928/01477447-20210414-04 (Epub 2021/05/28, PubMed PMID: 34039195).CrossRefPubMed

Pugely AJ, Martin CT, Gao Y, Mendoza-Lattes S, Callaghan JJ. Differences in short-term complications between spinal and general anesthesia for primary total knee arthroplasty. J Bone Jt Surg Am. 2013;95(3):193–9. https://doi.org/10.2106/jbjs.K.01682 (Epub 2012/12/28, PubMed PMID: 23269359).CrossRef

Protić A, Horvat M, Komen-Usljebrka H, Frkovic V, Zuvic-Butorac M, Bukal K, et al. Benefit of the minimal invasive ultrasound-guided single shot femoro-popliteal block for ankle surgery in comparison with spinal anesthesia. Wien Klin Wochenschr. 2010;122(19–20):584–7. https://doi.org/10.1007/s00508-010-1451-9 (Epub 2010/09/25, PubMed PMID: 20865457).CrossRefPubMed

10.

Zixuan L, Chen W, Li Y, Wang X, Zhang W, Zhu Y, et al. Incidence of deep venous thrombosis (DVT) of the lower extremity in patients undergoing surgeries for ankle fractures. J Orthop Surg Res. 2020;15(1):294. https://doi.org/10.1186/s13018-020-01809-0 (Epub 2020/08/02, PubMed PMID: 32736663; PubMed Central PMCID: PMCPMC7393865).CrossRefPubMedPubMedCentral

11.

AQC. AQC—Arbeitsgemeinschaft für Qualitätssicherung in den Chirurgischen Disziplinen 2022. https://aqc.ch. 2 Mar 2022.

12.

AG AS. AdjumedAnalyze 2022. https://adjumed.com/en/. 2 Mar 2022.

13.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12(12):1495–9. https://doi.org/10.1016/j.ijsu.2014.07.013 (Epub 2014/07/22, PubMed PMID: 25046131).CrossRef

14.

2016 W-I-V. International statistical classification of diseases and related health problems 10th revision: World health organization. 2022. https://icd.who.int/browse10/2016/en. Accessed 5 Mar 2022.

15.

Anderson JG, Bohay DR, Maskill JD, Gadkari KP, Hearty TM, Braaksma W, et al. Complications after popliteal block for foot and ankle surgery. Foot Ankle Int. 2015;36(10):1138–43. https://doi.org/10.1177/1071100715589741 (Epub 20150624, PubMed PMID: 26109605).CrossRefPubMed

16.

Richman JM, Liu SS, Courpas G, Wong R, Rowlingson AJ, McGready J, et al. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg. 2006;102(1):248–57. https://doi.org/10.1213/01.Ane.0000181289.09675.7d (Epub 2005/12/22, PubMed PMID: 16368838).CrossRefPubMed

17.

Peters ML, Sommer M, de Rijke JM, Kessels F, Heineman E, Patijn J, et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg. 2007;245(3):487–94. https://doi.org/10.1097/01.sla.0000245495.79781.65 (PubMed PMID: 17435557; PubMed Central PMCID: PMCPMC1877005).CrossRefPubMedPubMedCentral

18.

Vora M, Samineni AV, Sing D, Salavati S, Tornetta P 3rd. Spinal anesthesia associated with increased length of stay compared to general anesthesia for ankle open reduction internal fixation: a propensity-matched analysis. J Foot Ankle Surg. 2021;60(2):350–3. https://doi.org/10.1053/j.jfas.2020.08.035 (Epub 2021/01/20, PubMed PMID: 33461921).CrossRefPubMed

19.

Jordan C, Davidovitch RI, Walsh M, Tejwani N, Rosenberg A, Egol KA. Spinal anesthesia mediates improved early function and pain relief following surgical repair of ankle fractures. J Bone Jt Surg Am. 2010;92(2):368–74. https://doi.org/10.2106/jbjs.H.01852 (Epub 2010/02/04, PubMed PMID: 20124064).CrossRef

20.

Schade MA, Hollenbeak CS. Early postoperative infection following open reduction internal fixation repair of closed malleolar fractures. Foot Ankle Spec. 2018;11(4):335–41. https://doi.org/10.1177/1938640017735887 (Epub 2017/10/17, PubMed PMID: 29029574).CrossRefPubMed

21.

Louie PK, Schairer WW, Haughom BD, Bell JA, Campbell KJ, Levine BR. Involvement of residents does not increase postoperative complications after open reduction internal fixation of ankle fractures: an analysis of 3251 cases. J Foot Ankle Surg. 2017;56(3):492–6. https://doi.org/10.1053/j.jfas.2017.01.020 (Epub 2017/03/02, PubMed PMID: 28245974).CrossRefPubMed

22.

Rascoe AS, Kavanagh MD, Audet MA, Hu E, Vallier HA. Factors associating with surgical site infection following operative management of malleolar fractures at an urban level 1 trauma center. OTA Int. 2020;3(2):e077. https://doi.org/10.1097/oi9.0000000000000077 (Epub 20200506, PubMed PMID: 33937701; PubMed Central PMCID: PMCPMC8022901).CrossRefPubMedPubMedCentral

23.

Pflüger P, Wurm M, Biberthaler P, Pförringer D, Crönlein M. Analysis of 6851 foot and ankle injuries from 2010–2017 in an emergency department. Unfallchirurgie (Heidelb). 2022;125(10):801–10. https://doi.org/10.1007/s00113-021-01081-9 (Epub 20210930, PubMed PMID: 34591136; PubMed Central PMCID: PMCPMC9515139).CrossRefPubMed

24.

Vieira Cardoso D, Dubois-Ferrière V, Gamulin A, Baréa C, Rodriguez P, Hannouche D, et al. Operatively treated ankle fractures in Switzerland, 2002–2012: epidemiology and associations between baseline characteristics and fracture types. BMC Musculoskelet Disord. 2021;22(1):266. https://doi.org/10.1186/s12891-021-04144-5 (Epub 2021/03/13, PubMed PMID: 33706724; PubMed Central PMCID: PMCPMC7953683).CrossRefPubMedPubMedCentral

25.

Danilkowicz RM, Grimm NL, Kim J, O’Donnell JA, Allen NB, Adams SB. Increasing age and modifiable comorbidities are associated with short-term complications after open reduction and internal fixation of ankle fractures. Eur J Orthop Surg Traumatol. 2022;32(1):113–9. https://doi.org/10.1007/s00590-021-02927-z (Epub 2021/03/25, PubMed PMID: 33759030).CrossRefPubMed

26.

Gil JA, Goodman AD, Kleiner J, Walsh DF, Kosinski LR, Hsu R. Mortality and morbidity of surgical management of geriatric ankle fractures. J Am Acad Orthop Surg. 2020;28(16):678–83. https://doi.org/10.5435/jaaos-d-19-00048 (Epub 2020/08/10, PubMed PMID: 32769723).CrossRefPubMed

27.

Pilskog K, Gote TB, Odland HEJ, Fjeldsgaard KA, Dale H, Inderhaug E, et al. Association of delayed surgery for ankle fractures and patient-reported outcomes. Foot Ankle Int. 2022. https://doi.org/10.1177/10711007211070540 (Epub 2022/02/22, PubMed PMID: 35184581).CrossRefPubMedPubMedCentral

28.

De Las Heras Romero J, Lledó Alvarez A, Torres Sánchez C, Luna Maldonado A. Operative treatment of ankle fractures: predictive factors affecting outcome. Cureus. 2020;12(10):e11016. https://doi.org/10.7759/cureus.11016 (Epub 20201018, PubMed PMID: 33094040; PubMed Central PMCID: PMCPMC7574997).CrossRefPubMedPubMedCentral

29.

Velleman J, Nijs S, Hoekstra H. Operative management of AO type 44 ankle fractures: determinants of outcome. J Foot Ankle Surg. 2018;57(2):247–53. https://doi.org/10.1053/j.jfas.2017.08.021 (Epub 20171219, PubMed PMID: 29273186).CrossRefPubMed

30.

Vehling M, Canal C, Ziegenhain F, Pape HC, Neuhaus V. Short-term outcome of isolated lateral malleolar fracture treatment is independent of hospital trauma volume or teaching status: a nationwide retrospective cohort study. Eur J Trauma Emerg Surg. 2021. https://doi.org/10.1007/s00068-021-01771-4 (Epub 2021/08/17, PubMed PMID: 34398247).CrossRefPubMedPubMedCentral

31.

Arroyo-Johnson C, Mincey KD. Obesity Epidemiology Worldwide. Gastroenterol Clin North Am. 2016;45(4):571–9. https://doi.org/10.1016/j.gtc.2016.07.012 (PubMed PMID: 27837773; PubMed Central PMCID: PMCPMC5599163).CrossRefPubMedPubMedCentral

32.

Cardoso DV, Paccaud J, Dubois-Ferrière V, Barea C, Hannouche D, Veljkovic A, et al. The effect of BMI on long-term outcomes after operatively treated ankle fractures: a study with up to 16 years of follow-up. BMC Musculoskelet Disord. 2022;23(1):317. https://doi.org/10.1186/s12891-022-05247-3 (Epub 20220404, PubMed PMID: 35379212; PubMed Central PMCID: PMCPMC8978374).CrossRefPubMedPubMedCentral

33.

Smeeing DPJ, Briet JP, van Kessel CS, Segers MM, Verleisdonk EJ, Leenen LPH, et al. Factors associated with wound- and implant-related complications after surgical treatment of ankle fractures. J Foot Ankle Surg. 2018;57(5):942–7. https://doi.org/10.1053/j.jfas.2018.03.050 (Epub 2018/07/15, PubMed PMID: 30005967).CrossRefPubMed

34.

SooHoo NF, Krenek L, Eagan MJ, Gurbani B, Ko CY, Zingmond DS. Complication rates following open reduction and internal fixation of ankle fractures. J Bone Jt Surg Am. 2009;91(5):1042–9. https://doi.org/10.2106/jbjs.H.00653 (Epub 2009/05/05, PubMed PMID: 19411451).CrossRef

35.

Reider L, Pollak A, Wolff JL, Magaziner J, Levy JF. National trends in extremity fracture hospitalizations among older adults between 2003 and 2017. J Am Geriatr Soc. 2021;69(9):2556–65. https://doi.org/10.1111/jgs.17281 (Epub 2021/06/02, PubMed PMID: 34062611).CrossRefPubMed

36.

Basques BA, Miller CP, Golinvaux NS, Bohl DD, Grauer JN. Morbidity and readmission after open reduction and internal fixation of ankle fractures are associated with preoperative patient characteristics. Clin Orthop Relat Res. 2015;473(3):1133–9. https://doi.org/10.1007/s11999-014-4005-z (Epub 2014/10/23, PubMed PMID: 25337977; PubMed Central PMCID: PMCPMC4317425).CrossRefPubMed

37.

Happonen V, Kröger H, Kuismin M, Sund R. Ankle fractures in Finland: 118,929 operatively treated between 1987 and 2019. Acta Orthop. 2022;93:327–33. https://doi.org/10.2340/17453674.2022.2071 (Epub 2022/02/12, PubMed PMID: 35147707; PubMed Central PMCID: PMCPMC8833737).CrossRefPubMedPubMedCentral

38.

Maxwell BG, Spitz W, Porter J. Association of increasing use of spinal anesthesia in hip fracture repair with treating an aging patient population. JAMA Surg. 2020;155(2):167–8. https://doi.org/10.1001/jamasurg.2019.4471 (Epub 2019/11/21, PubMed PMID: 31746959; PubMed Central PMCID: PMCPMC6902104).CrossRefPubMed

39.

Capdevila X, Aveline C, Delaunay L, Bouaziz H, Zetlaoui P, Choquet O, et al. Factors determining the choice of spinal versus general anesthesia in patients undergoing ambulatory surgery: results of a multicenter observational study. Adv Ther. 2020;37(1):527–40. https://doi.org/10.1007/s12325-019-01171-6 (Epub 2019/12/13, PubMed PMID: 31828612; PubMed Central PMCID: PMCPMC6979445).CrossRefPubMed

40.

Harbell MW, Methangkool E. Patient safety education in anesthesia: current state and future directions. Curr Opin Anaesthesiol. 2021;34(6):720–5. https://doi.org/10.1097/aco.0000000000001060 (PubMed PMID: 34817450).CrossRefPubMed

Title: Does the type of anesthesia (regional vs. general) represent an independent predictor for in-hospital complications in operatively treated malleolar fractures? A retrospective analysis of 5262 patients
Authors: Claudio Canal
Alexander Kaserer
Laurent Sébastien Morax
Franziska Ziegenhain
Hans-Christoph Pape
Valentin Neuhaus
Publication date: 15-02-2023
Publisher: Springer Berlin Heidelberg
Keywords: Ankle Fracture
General Anesthesia
Published in: European Journal of Trauma and Emergency Surgery / Issue 3/2023
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-023-02235-7

At a glance: The STEP trials

Springer Medicine

Does the type of anesthesia (regional vs. general) represent an independent predictor for in-hospital complications in operatively treated malleolar fractures? A retrospective analysis of 5262 patients

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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