COVID-Positive Ankle Fracture Patients are at Increased Odds of Perioperative Surgical Complications Following Open Reduction Internal Fixation Surgery

Who: Michael R. Mercier, BA; Anoop R. Galivanche, BS; Jordan P. Brand, MD; Neil Pathak, MD; Michael J. Medvecky, MD; Arya G. Varthi, MD; Lee E. Rubin, MD; Jonathan N. Grauer, MD

Journal: PLOS ONE

Overview: Ankle fractures have continued to occur through the COVID pandemic and, regardless of patient COVID status, often need operative intervention for optimizing long-term outcomes. For healthcare optimization, patient counseling, and care planning, understanding if COVID-positive patients undergoing ankle fracture surgery are at increased risk for perioperative adverse outcomes is of interest.

The COVID-19 Research Database contains recent United States aggregated insurance claims. Patients who underwent ankle fracture surgery from April 1st, 2020 to June 15th, 2020 were identified. COVID status was identified by ICD coding. Demographics, comorbidities, and postoperative complications were extracted based on administrative data. COVID-positive versus negative patients were compared with univariate analyses. Propensity-score matching was done on the basis of age, sex, and comorbidities. Multivariate regression was then performed to identify risk factors independently associated with the occurrence of 30-day postoperative adverse events.

In total, 9,835 patients undergoing ankle fracture surgery were identified, of which 57 (0.58%) were COVID-positive. COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including: chronic kidney disease, diabetes, hypertension, and obesity (p<0.05 for each). After propensity matching and controlling for all preoperative variables, multivariate analysis found that COVID-positive patients were at increased risk of any adverse event (odds ratio [OR] = 3.89, p = 0.002), a serious adverse event (OR = 5.48, p = 0.002), and a minor adverse event (OR = 3.10, p = 0.021).

COVID-positive patients will continue to present with ankle fractures requiring operative intervention. Even after propensity matching and controlling for patient factors, COVID-positive patients were found to be at increased risk of 30-day perioperative adverse events. Not only do treatment teams need to be protected from the transmission of COVID in such situations, but the increased incidence of perioperative adverse events needs to be considered.

The current study found that 0.58% of ankle fracture surgery patients during the study period were positive for COVID. COVID-positivity conferred a significantly increased odds of adverse events postoperatively. This difference remained even after controlling for patient demographics and comorbidity burden. These findings suggest that surgery should be undertaken cautiously in patients who have or may have COVID, not just for the safety of providers, but also patients. As hospital environments continue to be exposed to COVID and there is the concern of further waves of the pandemic, care must be taken when treating COVID-positive ankle fracture patients.