Outpatient Nonunion Fracture Repair of the Lower Extremity is Safe with Appropriate Patient Selection: A Propensity-Matched Database Analysis

Background: With rising healthcare costs and advances in surgical and anesthetic techniques, outpatient surgery has become increasingly common. This study evaluates differences in postsurgical complications between inpatient and outpatient femur and tibia nonunion fracture repairs. Materials and Methods: Adult patients who underwent femur and tibia nonunion repair were identified in the American College of Surgeons National Surgical Quality Improvement Program database (2015–2020) and categorized by inpatient or outpatient status. Propensity score matching was used to reduce confounding factors, and complications were classified as major, minor, or any adverse event. Univariate and logistic regression analyses determined complication differences, with significance set at P < 0.05. Results: Among 827 patients (418 femur and 409 tibia), propensity-matched analysis revealed no statistically significant difference in major complications between inpatient and outpatient groups for femur (7% vs. 1.7%, P = 0.158) and tibia (5.4% vs. 5.1%, P = 0.886) cases. However, minor complications, particularly postoperative blood transfusions, were higher in inpatients (femur: 17.5% vs. 3.4%, P = 0.012; tibia: 4.8% vs. 1.1%, P = 0.048). Excluding transfusions, no statistically significant differences were found in major, minor, or adverse events. Conclusion: Inpatient and outpatient femur and tibia nonunion repairs demonstrate no difference in adverse events, supporting outpatient procedures when patients are carefully selected and hemodynamically optimized. Further studies are recommended to support patient safety and equity in outpatient nonunion repair for lower extremity fractures.