Patient Comorbidities Drive 90-Day Emergency Department Revisits and Readmissions After Trimalleolar Ankle Fracture Open Reduction and Internal Fixation: A National Database Analysis

INTRODUCTION: Trimalleolar ankle fractures are associated with high complication rates and unplanned healthcare utilization. This study aimed to (1) characterize the demographic and clinical profile of patients requiring 90-day readmission; (2) identify risk factors for 90-day emergency department (ED) utilization; and (3) determine comorbidities most strongly linked to 90-day readmissions following trimalleolar open reduction and internal fixation (ORIF). METHODS: Using the PearlDiver Mariner database from 2010 to 2021, patients undergoing trimalleolar ankle fracture ORIF were identified through current procedural terminology codes 27822 and 27823. Ninety-day postoperative ED visits and hospital readmissions were evaluated. Patients with ED utilization (N = 636) were compared with controls without ED visits (N = 79,956). Logistic regression was used to identify demographic and comorbidity risk factors for both ED utilization and readmission, with statistical significance set at P < 0.05. RESULTS: ED utilization was higher among older patients (peak 70 to 74 years, P < 0.001). Comorbidities markedly associated with 90-day ED revisits included congestive heart failure (CHF) [odds ratio (OR) 1.55, P = 0.001], fluid and electrolyte disorders (OR 1.35, P = 0.001), pathologic weight loss (OR 1.34, P = 0.012), hypertension (OR 1.26, P = 0.043), and peripheral vascular disease (PVD) (OR 1.25, P = 0.038). Risk factors for 90-day readmission included fluid and electrolyte disorders (OR 1.98, P < 0.001), coagulopathy (OR 1.44, P < 0.001), CHF (OR 1.35, P < 0.001), PVD (OR 1.33, P < 0.001), and pathologic weight loss (OR 1.44, P < 0.001). CONCLUSION: Postoperative ED visits and readmissions following trimalleolar ORIF are driven largely by patient comorbidities. Older, medically complex patients represent a high-risk group, and targeted perioperative optimization may reduce complications and unplanned healthcare utilization.