Is Discharging Patients After External Fixation and Between Stages During Periarticular Lower Extremity Fracture Care Safe?

Abstract

To investigate whether discharge between stages for lower extremity periarticular fracture surgery affected complication rates and hospital length of stay. It was hypothesized that patients discharged between stages experienced more complications and readmissions but shorter duration of hospitalization. Design: Retrospective. Single academic Level 1 trauma center. Patients with tibial plateau (AO/OTA 41B/C) and pilon (43B/C) fractures treated in staged fashion were included. Patients were grouped by whether they were discharged or remained admitted (hospitalized) between stages. Patient factors, total duration of stay, time between stages, and complications were evaluated and compared. A total of 102 patients were included in the study (mean age=44.0 (range 14-75); 63.7% male). Of these, 28 were discharged between stages (mean age=45.5, (range 17-75); 60.7% male), while 74 remained admitted (mean age=43.4 (range 14-75); 64.9% male). There were no differences between the groups with regard to age (p=0.548), sex (p=0.697), BMI (30.8 vs 30.5, p=0.839), homelessness (7.1% vs 20.3%, p=0.143), diabetes (3.6% vs 12.2%, p=0.278), smoking status (32.1% vs 37.8%, p=0.593), substance use (21.4% vs 41.9%, p=0.055), OTA/AO classification (p =0.721), or Gustilo-Anderson classification (p=0.452). The hospitalized group had a higher mean Injury Severity Score (12.6 vs 6.6, p<0.001). Discharged patients had higher rates of pin-site infection that occurred between stages (14.3% vs 2.7%, p=0.047), longer time between stages (17.5 vs 10.8 days, p<0.001), and shorter combined total hospital length of stay (7.1 vs 22.6 days, p<0.001).There was no difference in rates of nonunion (9.1% vs 13.7%, p=0.719), deep infection (18.2% vs 25.9%, p=0.566), superficial infection (9.1% vs 3.4%, p=0.303), and unplanned reoperation (36.4% vs 36.2%, p=1.000) between the groups. Patients with tibial plateau and pilon fractures who were discharged home between external fixation and definitive fixation had more temporary pin site infections and longer time between stages, but no increase in long term complications and spent fewer total days in the hospital compared to patients who remained hospitalized between stages. The group of patients who remained hospitalized between stages had a higher mean ISS. III.