Incidence and Predictors of Early Postoperative Complications in Operative Management of Ankle Fractures: A Multivariable Approach

Background: Despite standardization of treatment for ankle fractures, postoperative complications continue to pose a challenge. Previous studies focused on the association between patient-specific factors and early complications; less is known about fracture- and treatment-related factors. This study aimed to identify independent predictors of early postoperative complications in ankle fractures by including patient, fracture, and treatment-related factors. Methods: This was a retrospective single-center analysis of consecutive patients with surgically treated ankle fractures at a Level 1 trauma center (2013–2019). The main outcome was the time to the occurrence of an early post-operative complication, defined as an event requiring emergency medical consultation within the first 90 days after definitive fracture stabilization, deviating from the hospital’s standard aftercare protocol. Four different Cox regression analyses were performed to identify significant independent risk factors with the best fit. Results: Around 25% of the patients with ankle fractures developed an early postoperative complication. The multivariable Cox regression analysis revealed the following predictors of early complications: diabetes, substance abuse, older age, type of fracture, and insufficient/missing plaster reduction. Conclusion: Nearly one quarter of our patients developed an early postoperative complication. While some of the predictors of early complications cannot be modified, others might serve as targets for improving outcomes and reducing morbidity of ankle fracture surgeries.