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Ambulante Versorgung operativer Spunggelenkfrakturen an einem US-Traumazentrum

Ein valides Modell im DRG-Zeitalter?

Surgical treatment of ankle fractures as an outpatient procedure

A safe and resource-efficient concept?

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Zusammenfassung

Hintergrund

In Deutschland werden Patienten mit operativ zu versorgender Fraktur des oberen Sprunggelenks (OSG) überwiegend stationär behandelt, basierend auf der Prämisse, dass die stationäre Überwachung der Weichteilverhältnisse zu einer Reduktion postoperativer Komplikationen führt. Die vorliegende Studie überprüft die Hypothese, dass die ambulante Versorgung operativer Sprunggelenkverletzungen nicht mit einer erhöhten Komplikationsrate einhergeht.

Methodik

Es handelt sich um eine retrospektive Analyse einer prospektiven Datenbank in einem 5-Jahres-Zeitraum (01.01.2005–31.12.2009) an einem akademischen Level-1-Traumazentrum in USA mit institutionellem Protokoll der generell ambulanten Versorgung isolierter Frakturen des OSG. Alle Frakturen wurden nach dem AO/OTA-System klassifiziert. Das Ziel der Studie war die Analyse der Rate postoperativer Komplikationen und notwendiger Revisionseingriffe bei ambulant versorgten vs. stationär behandelten Patienten.

Ergebnisse

Von 810 prospektiv erfassten Patienten mit OSG-Verletzungen erfüllten 476 die Einschlusskriterien. Davon wurden 256 (53,8%) Patienten ambulant behandelt. Die mittlere Verweildauer der stationär aufgenommenen Patienten betrug 1,5±0,8 (1–5) Tage. Die Alterverteilung in beiden Gruppen lag in einem ähnlichen Bereich (39±14,1 stationär vs. 35±12,8 Jahre ambulant), und der Schweregrad der Verletzungen nach der AO/OTA-Klassifikation war in beiden Gruppen vergleichbar. Die Rate der postoperativen Komplikationen (9,1% vs. 3,1%) und der notwendigen chirurgischen Revisionseingriffe (3,6% vs. 1,2%) war signifikant erhöht in der Gruppe der stationär versorgten Sprunggelenkfrakturen, im Vergleich zu den ambulanten Operationen (p<0,05).

Schlussfolgerung

Die ambulante operative Versorgung von isolierten Frakturen des OSG stellt ein sicheres und effizientes Konzept dar, welches nicht mit einer erhöhten Komplikationsrate einhergeht. Die Implementation dieses Modells sollte im Zeitalter der fallpauschalenbasierten Vergütung von Krankenhausleistungen prinzipiell in Betracht gezogen werden. Allerdings sind kulturelle Unterschiede in der häuslichen Versorgungssituation der Patienten zu bedenken.

Abstract

Background

In many European countries, patients requiring surgical treatment of ankle fractures are generally hospitalized for an average of 8–11 days. This anecdotal concept is largely based on the premise that the inpatient monitoring of soft tissue conditions may lead to a decreased complication rate. The present study was designed to test the hypothesis that the surgical care of isolated ankle fractures as an outpatient procedure represents a safe and feasible concept which is not associated with an increased complication rate.

Methods

A retrospective analysis was performed of a prospective database during a 5-year period (01/01/2005–12/31/2009) at a US academic level 1 trauma center with an institutional protocol of outpatient surgery for isolated ankle fractures. All fractures were classified according to the AO/OTA system. Outcome parameters consisted of the rate of postoperative complications and frequency of unplanned surgical revisions outpatient isolated versus inpatient isolated with surgical fixation of ankle isolated fractures.

Results

Among 810 consecutive patients with ankle fractures during the study period, 476 met the inclusion criteria. Of these, 256 patients (53.8%) were treated as outpatients. The average length of stay of patients who were admitted as inpatients was 1.5±0.8 days (range 1–5 days). The age distribution was in a similar range for inpatients and outpatients (39±14.1 vs 35±12.8 years), and the injury severity based on the AO/OTA fracture classification revealed a similar distribution of fracture patterns in both groups. The rate of postoperative complications (9.1 vs 3.1%) and of unplanned surgical revisions (3.6 vs 1.2%) was significantly increased in the hospitalized group, compared to patients with ambulatory surgery (P<0.05).

Conclusion

The surgical treatment of isolated ankle fractures as an outpatient procedure represents a safe and resource-efficient concept which is not associated with an increased complication rate. Cultural differences in the domestic environment of individual patients may have to be taken into consideration.

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Authors and Affiliations

  1. Denver Health Medical Center, Department of Orthopaedic Surgery, University of Colorado Denver, School of Medicine , 777 Bannock Street, 80204, Denver, USA

    S. Weckbach, M.A. Flierl & P.F. Stahel MD, FACS

  2. Klinik für Unfall-, Hand-, plastische und Wiederherstellungschirurgie, Universitätsklinik Ulm, Ulm, Deutschland

    S. Weckbach, M. Huber-Lang & F. Gebhard

  3. Department of Neurosurgery, School of Medicine, University of Colorado, Denver, Denver, USA

    P.F. Stahel MD, FACS

Authors
  1. S. Weckbach
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  2. M.A. Flierl
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  3. M. Huber-Lang
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  4. F. Gebhard
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  5. P.F. Stahel MD, FACS
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Correspondence to P.F. Stahel MD, FACS.

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Weckbach, S., Flierl, M., Huber-Lang, M. et al. Ambulante Versorgung operativer Spunggelenkfrakturen an einem US-Traumazentrum. Unfallchirurg 114, 938–942 (2011). https://doi.org/10.1007/s00113-011-2066-y

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  • DOI: https://doi.org/10.1007/s00113-011-2066-y

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