Introduction

Greater length of stay (LOS) after elective surgery results in increased use of health care resources and higher costs. Within the realm of foot and ankle surgery, improved perioperative care has enabled a vast majority of procedures to be performed as a day surgery. The objective of this study was to determine the perioperative factors that predict a prolonged LOS after elective ankle replacement or fusion.

Purpose

Weight loss is often advised to our patients and considered to make a substantial difference in most musculoskeletal symptoms. Patients with end stage ankle arthrosis have severe pain, diminished health related quality of life, and limited physical function.

They frequently refer to increased weight as a simple indicator of decline in their quality loose weight. Patients assume that weight loss will follow after surgery secondary to increased activity with reduced pain and disability.

Purpose: The optimal timing for surgical stabilization of the fractured spine is controversial. Early stabilization facilitates earlier mobilization and theoretically reduces associated complications.

Method: Consecutive patients requiring stabilization surgery for a spinal fracture, without neurological injury were identified from a prospective institutional database. Patients were stratified by the time to their final surgical stabilization procedure (< 12, 12–24, 24–48, 48–72 and > 72 hours) and outcomes compared. Multivariate analyses were performed to explore potential confounding effects.

Results: 76 patients satisfied the inclusion/exclusion criteria. The median time to final surgical spinal stabilization was 71.8 hours. There were significant differences in complications related to prolonged recumbancy (e.g. respiratory failure, thromboembolism, p = 0.016) between the different time frames. Graphical exploration suggested higher complication rates after 48 hours delay. Comparing patients stabilized after 48 hours compared to those within, there was a 6.9 times (p = 0.0085) greater risk of a complication related to prolonged recumbancy. These effects remained significant after multivariate adjustments for age, comorbidity and ISS. There were trends towards longer lengths of stay and lower function (measured using the FIM) at discharge in the surgical delay group.

Conclusion: This study demonstrates a strong relationship between surgical delay and complications. The cutoff for this delay appears to occur at 48 hours. This study is limited in that the identified relationship may be related to a number of other confounding factors not measured or inadequately adjusted for because of small numbers. Further study, using this study’s developed algorithms in larger datasets, may help resolve some of these issues.