Does Subspecialty Matter: Outcomes after Ankle Fracture Surgery

Category: Ankle; Trauma Introduction/Purpose: Orthopaedists are increasingly pursuing subspecialization after residency. However, few studies have compared ankle fracture surgery outcomes between orthopaedists from different subspecialty backgrounds. This study aims to investigate the effect of subspecialization on patient outcomes following surgical intervention for ankle fractures. Methods: The PearlDiver M161 Ortho administrative dataset was utilized to identify patients (average age: 54.48) who received ankle fracture surgery. Cohorts were created based on the subspecialty of the operating surgeon (foot & ankle, trauma, non-foot & ankle non-trauma). Rates of surgeon-reported medical and surgical adverse events within 90 days were compared between the three fellowship cohorts using multivariate logistic regression with the “non-foot&ankle non-trauma” cohort serving as the reference. 5-year implant removal rates were also compared between cohorts using a Kaplan-Meier curve. Results: Data from 146,421 patients receiving ankle fracture surgery were assessed (70.0% female). No significant differences were found in 5-year implant removal rates between the fellowship cohorts (p=0.8). Compared to the other cohorts, the foot&ankle subspecialty cohort demonstrated significant decreases in major adverse events (OR: 0.82 [0.74-0.91], p< 0.001), which was comprised of decreases in acute kidney injuries (OR: 0.75 [0.62-0.91], p=0.005), pneumonia (OR: 0.70 [0.56-0.87], p=0.002), and urinary tract infections (OR: 0.79 [0.68-0.91], p=0.001) following ankle fracture surgery. The foot & ankle cohort also demonstrated lower readmission rates (OR: 0.79 [0.67-0.93], p< 0.005). Conclusion: Foot & ankle surgeons demonstrated superior perioperative outcomes and readmission rates for their patients following ankle fracture surgery compared to trauma surgeons and orthopaedic surgeons of other subspecialty backgrounds.