How Does Alcohol Use Disorder Impact Morbidity, Readmission Rates, and HealthCare Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Fractures?

Abstract

Category: Ankle; Trauma Introduction/Purpose: Bimalleolar ankle fractures are a common injury that can be treated with open reduction and internal fixation (ORIF). However, there is a paucity of literature evaluating the impact of patients with alcohol use disorder (AUD) on postoperative complications following ORIF of bimalleolar ankle fractures. Therefore, the purpose of this study is to investigate whether patients with AUD undergoing ORIF of bimalleolar ankle fractures have higher odds of (1) morbidity; (2) readmissions; and (3) costs of care. Methods: A retrospective query of the PearlDiver nationwide claims database was performed between January 2010 and October 2020. Baseline demographics were analyzed using Pearson’s Chi-Square Analyses. Multivariate binomial logistic regression was utilized to calculate the effect of AUD on 90-day medical complications. Costs of care were compared using Welch’s t-tests. A P value less than 0.001 was considered to be statistically significant. Results: The query yielded 64,563 patients within the study (AUD = 8,177; control = 56,386). Patients who have AUD were found to have significantly higher incidence and odds of developing 90-day medical complications (59.35% vs. 18.77; OR: 2.30; 95% CI: 2.16 to 2.46; p < 0.0001). AUD patients were found to have higher incidences of 90-day readmissions (9.14% vs. 5.56; OR: 0.95; 95% CI: 0.86 to 1.05; p=0.361); however, this failed to reach statistical significance. Patients with AUD also incurred significantly higher day of surgery costs ($4,433.33 vs. $3,979.85, p< 0.0001) and 90-day episode of care costs ($8,523.40 vs. $6,976.95, p< 0.0001). Conclusion: AUD patients have higher odds of 90-day postoperative complications and costs of care following ORIF of bimalleolar ankle fractures. The findings of this study can be used by orthopaedic surgeons to reduce healthcare costs as well as improve postsurgical outcomes by educating patients who have AUD on the potential complications that they may encounter after their procedure.