OBJECTIVES : Ankle fracture outcomes are poorly defined. This study assesses surgical treatment, payments from commercial insurance, and complication rates in patients diagnosed with ankle fractures.

METHODS : Patients (18-64 years old) within the IBM MarketScan® Commercial database with an in- or outpatient diagnosis of ankle fracture treated surgically between 10/1/2015 – 7/31/2020 were identified. Eligible patients had continuous enrollment for one-year prior and post ankle fracture diagnosis (defined as the “index”). Variables included patient demographics, comorbidities and surgical intervention type at time of index. All patients were followed one-year post surgery. Outcomes included complication rates (infection, non-union, implant removal, pain after 30 days postoperative (residual pain), new occurrence of arthritis, and instability) and 1-year payments. Standard descriptive statistics (proportion, mean, median) were calculated on all variables and outcomes. Generalized linear models (link: log, family type: gamma) and logistic regression models were built to define costs and risk factors for complications.

RESULTS : 31,327 surgically treated patients were identified (mean age: 42 (SD: 15.75), (59% female). Site of care was mostly outpatient (58% surgeries), 26% and 15% were inpatient and ambulatory surgical site cases, 1% other. One-year post-operative complications rates were: 1.6% infection, 2.3% non-union, 2.3% implant removal, 2.1% instability, 33.8% pain, 3.6% arthritis. Outpatient and inpatient payments averaged $8,441(SD: $18,448.17) and $40,776(SD: $64,020.81). Pain and infection resulted in increased payments (payment difference with versus without pain: $13,532, 95% confidence interval (CI): $11,089-$16,354, P= 0.0441; payment difference with vs without infection: $66,932, 95% CI: $49,719-$90,101, P<.0001). Syndesmosis was significantly associated with residual pain (OR: 1.17, CI:1.11-1.23, p <.0001).

CONCLUSIONS : 46% patients experienced any complications after ankle surgery. Further research is warranted to identify medical technologies to improve outcomes and reduce cost.