Scholars@Duke publication: Inpatient versus outpatient fixation of ankle fractures: An update on short-term postoperative complication risk and identification of common fracture types and independent risk factors.

Inpatient versus outpatient fixation of ankle fractures: An update on short-term postoperative complication risk and identification of common fracture types and independent risk factors.

Publication , Journal Article

Peri, MI; Hopper, H; O'Neill, CN; Cassidy, B; Cuthbert, AS; Anastasio, A; Patel, TT; Adams, S

Published in: J Foot Ankle Surg

January 19, 2026

BACKGROUND: Ankle fractures are a common orthopedic injury often requiring surgical fixation. Prior studies have found that inpatient treatment is associated with increased risk of 30-day complications versus outpatient treatment. PURPOSE: As outpatient fixation becomes increasingly common, and as surgical and rehabilitation techniques continue to evolve, we aim to provide an updated analysis of short-term complications following inpatient and outpatient management of ankle fractures. STUDY DESIGN: A retrospective cohort study was conducted. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients receiving surgery for ankle fracture from 2010-2021. Cohorts were divided by treatment setting and matched using the nearest neighbor method. A sub-analysis was performed to determine the most common fracture types treated for each cohort. Chi-square and independent t-tests were employed to evaluate for differences in 30-day complications. Regression analyses were employed to assess independent risk factors for adverse outcomes. RESULTS: 21,612 inpatient and 23,932 outpatient ankle fractures were identified, with 4,926 patients included per matched cohort. Inpatients had more bimalleolar and trimalleolar fractures, while outpatients had more lateral malleolus fractures. ASA class and prevalence of heart failure remained significantly higher in the inpatient cohort after matching. Rate of postoperative complications was greater for inpatients (6.1%) versus outpatients (2.6%). Greater age, ASA class, dependent functional status, preoperative blood transfusion, and various comorbidities were found to be independent risk factors for complications, regardless of surgical setting. CONCLUSIONS: Inpatient management of ankle fractures resulted in more postoperative complications compared to outpatient treatment. Preoperative characteristics, including patient comorbidities, may contribute to this difference. Additionally, there are several risk factors for adverse postoperative outcomes that should be considered prior to any fixation, regardless of surgical setting. Understanding these relationships can help surgeons better optimize patients and mitigate costs of care.