REPRESENTATION – REHOSPITALISATION FOLLOWING FOOT AND ANKLE SURGERY

Abstract

We audited all patients who underwent Foot and Ankle surgery at the University Hospital of Wales over one financial year (April 2007 – March 2008).

Patients were identified from the hospital OPCS-4 coding system and all scheduled and unscheduled visits to hospital investigated. Both trauma and elective patients were included. Patients were followed up for a mean period of 9 months (Range 1–14 months) following surgery.

The records for 1052 patients were evaluated. Of these, 77% were elective cases and 23% were trauma related. Overall about 10 % of our foot and ankle patients (100/1052) either attended the A& E Department or had an unplanned clinic visit at some stage of their follow up. Three quarters of these patients were admitted to hospital (median stay 1 day, range 1–51 days).

Twenty five patients (24 A& E; 1 medical) simply re-attended, but were not admitted. The majority of these (58%) had plaster-related problems (8\24) or superficial wound infections (6/24). The remaining patients presented with pain around the operated area, and were discharged after investigation. One patient presented to the physicians 44 days after excision of a Morton’s neuroma with a DVT.

Seventy five patients (7%) were re-admitted to hospital. Two were admitted under the physicians: one with a pulmonary embolus (30 days post ORIF ankle) and one following a cardiac arrest (20 days post ORIF ankle). Out of the remainder 34 patients had planned removal of metalwork, 9 patients had metalwork removed because of infection and 21 patients had soft-tissue infection requiring antibiotics or debridement. Overall, 9 patients underwent revision surgery (0.85%).

The overall infection and thromboembolic rate was 3.42 %(6 A& E + 30 T& O/1052) and 0.28% (1A& E + 2 medical/1052) respectively.