Abstract
In patients with an ankle fracture initial delay to operation because of time constraints is often prolonged because swelling precludes surgery for some days. We made use of a year long prospective audit of 2000 trauma patients to analyse the effect of delay to surgery on length of stay in ankle fracture patients.
One hundred and fifty patients were admitted with an ankle fracture. One hundred and twenty nine were operated on. The median (inter quartile range) time to surgery was 3 (2–5) days. Twenty six patients got to theatre within 24 hours. For those who didn’t get to theatre within 24 hours the median time to surgery was 4 days.
For the group as a whole there was a poor correlation between wait for surgery and length of stay (Pearson = 0.6). For the 98 patients under the age of 60 there was a significant relationship (Pearson co-efficient = 0.85). Fifty per cent of those under 60 were discharged within 48 hours of their surgery. The number of co-morbidities was different between the under and over 60s. The over 60s had a median (inter quartile range) of 2 (1–5) co-morbidities, compared to 0 (0–1) in those under 60.
Patients under 60 with an ankle fracture are generally medically fit. If 90% of such patients had their fractures fixed within 24 hours the median post operative length of stay for all ankle fractures in this population would fall from 7 to 3 days and the number of bed days saved would be 400 a year. The length of stay in patients over the age of 60 is more related to their associated co-morbidities than their time to surgery.
Correspondence should be addressed to Ms Larissa Welti, Scientific Secretary, EFORT Central Office, Technoparkstrasse 1, CH-8005 Zürich, Switzerland
