Translated article] Position statement relating ankle fractures in major outpatient surgery

Abstract

IntroductionThe increase in the prevalence of osteoporosis associated with ageing, and sports and traffic accidents, are responsible for the increase in ankle fractures. This fact emphasises the need to protocolise their care in order to provide greater clinical benefit to patients, and better cost–benefit ratios to the health system. Aim and methodAt present, there is no common framework for implementation of protocols and internal circuits of the Spanish centres for ankle fractures by means of major outpatient surgery (MOS), which is the final objective of this position paper. For this, the clinical and economic evidence of MOS, the local environment and the strategies for its implementation are reviewed, related to ankle fractures. Clinical and economic evidenceThe results showed a better cost–benefit ratio in outpatients compared to traditional hospitalisation, with lower complications and readmission rates and therefore significant cost savings. Barriers and strategiesGeneral and specific barriers are reviewed, as well as strategies and circuits for proper implementation. ResultsThe results show lower complication and readmission rates together with significant cost savings. It entails a better cost–benefit ratio in outpatient care compared to traditional hospitalisation. Position statementThe implementation of MOS contributes to improve the quality of care, and the satisfaction of both, patient and health care team, while optimising the utilisation of resources. Ankle fractures in patients selected for both the underlying pathology, anaesthetic risk, and the type of fracture can be operated satisfactorily under the MOS.