Hello, my name is Lisa Moscow, and I'm currently a medical student at the George Washington University schools medicine and health sciences in Washington, D. C. And today I will be presenting a project. I'm looking at the association of bleeding disorders. And the risk of complications following open reduction, internal fixation of the ankle. Our disclosures can be found on the my academy app. Start off with, I want to give a little bit of background about ankle fractures and treatment options for these fractures. Ankle fractures are generally broken up into 2 different groups. Of injury pattern, the 1st group are high impact, high energy fractures, which are generally seen. In the younger and athletic patient population. The 2nd, type of injury patterns are the low energy, low impact. Fractures, which are usually seen and the elderly population, or those patients who are at risk for following. Patients are usually given the option to manage their fracture. Not operatively as well as operatively among the operative treatment options, open reduction, internal fixation of the ankle is the most common procedure performed. Diabetes peripheral vascular disease and osteoporosis have all been identified as risk factors for post-operative complications following surgery for ankle fractures. Bleeding disorders have been studied, but have only been found to be a risk factor for complications following total hip and total knee replacements thus far. There are no studies looking at the impact of a patient having a bleeding disorder on their outcomes following. Operative treatment for ankle fractures, therefore, the purpose of the study was to determine the post-operative complication rate. Following of the ankle and patients with a bleeding disorder versus those without a bleeding disorder. By evaluating 30 day, post-operative outcome, the need for post-operative transfusion, readmission. Or re, operation and the length of stay, we utilize the national surgical quality improvement program database. To identify patients who underwent or off of the ankle using CPT codes. Our patient population consists of patients who underwent this procedure between the years of 2006 and 2018. The 2 patient cohorts that were defined for patients with a bleeding disorder and those without a bleeding disorder. Patients with a bleeding disorder where those patients who had an underlying hematological disorder. Such as vitamin K deficiency, hemophilia or thrombocytic. Additionally, leading disorder patients who were included in the study. Had a diagnosis of a hematological disorder and their medical records that was active at the time of the surgery. Patients with active heparin induced thrombocytopenia. Or a past medical history of thrombocytopenia and low play account at the time of surgery. Or vulnerable brands disease were also included in this patient cohort. Additionally, patients who are on chronic anti-coagulation therapy. Such as anti-coagulants and play agents. Other than aspirin or thrombin inhibitors that have not been discontinued prior to surgery. We're also classified as having a bleeding disorder. We utilized by area and multivariate analysis. To analyze the demographics, medical comorbidities and post operative complications. Between the 2 cohorts of the 10,306 patients undergoing operative treatment for ankle fractures. 9,909 patients had no bleeding disorder. Or a 397 were identified to have a bleeding disorder. Patients with the bleeding disorder were more likely to have comorbidities, including congestive heart failure. Hypertension and renal failure requiring dialysis. Following adjustment on multivariate analysis, patients with a bleeding disorder had an increased risk of any post operative complication within 30 days of the. Initial procedure, as well as requirement for post operative blood transfusion and extended length of hospital stay. Extended length of hospital stay was defined as a stay greater than 5 days. The corresponding ratios and P values can be seen in table 1. In conclusion, patients with bleeding disorders are an increased risk of post operative complications following for ankle fracture. By determining patient risk factors, a more individualized preoperative and perioperative plan can be created to optimize patient outcomes. In order to create this more individualized plan, a multidisciplinary team, including a hematologist. In addition to the surgeon and anesthesiologist can be formed. By reducing post operative complications, we can improve patient satisfaction and overall. Reduce the health care costs that patients and the health care system. Thank you so much.

bleeding disorders

ankle fractures

post-operative complications

transfusion

patient outcomes