# Feasibility and Safety of Home-Based Preoperative Management of Selected Lower Extremity Trauma

## TL;DR

This study shows that some patients with lower leg injuries can safely stay at home before surgery, reducing hospital use.

## Contribution

The study introduces a structured home-based preoperative pathway for lower extremity trauma patients.

## Key findings

- 87.7% of patients completed the preoperative period at home without returning to the Emergency Department.
- Patients returning to the ED preoperatively had a higher chance of postoperative ED visits.
- Time to surgery was not linked to postoperative ED visits.

## Abstract

Background/Objectives: Efficient allocation of hospital resources is crucial in managing lower extremity trauma. Selected patients with stable injuries may not require inpatient hospitalization while awaiting surgical fixation. This study describes the feasibility and safety of a structured Home-based Preoperative Management (HPM) pathway for such patients. Methods: We conducted a retrospective, single-center observational study of 187 adult patients with isolated lower extremity fractures managed with HPM between 2019 and 2022. All patients were discharged home from the Emergency Department with standardized instructions, immobilization, anticoagulation, and planned follow-up. No comparator group was included. Results: Of 187 patients (mean age 49.7 y), 23 patients (12.3%) returned to the Emergency Department during the preoperative waiting period. The mean time from Emergency Department presentation to surgery was 8.5 days. Overall, 164 patients (87.7%) completed the preoperative waiting period at home without requiring an additional Emergency Department visit. Within one year after surgery, 51 patients (27.3%) presented to the Emergency Department; 29 of these visits (56.9%) were considered surgery-related. Patients who returned to the Emergency Department before surgery had a higher likelihood of postoperative Emergency Department visits within one year compared with those who did not (69.6% versus 21.3%, p < 0.001). Time to surgery was not associated with postoperative Emergency Department visits (p = 0.763). Conclusions: In this retrospective cohort, Home-Based Preoperative Management was feasible and appeared safe for carefully selected patients with lower extremity trauma. Most patients were able to await surgery at home without unplanned Emergency Department visits. Given the absence of a comparator group, no conclusions regarding comparative effectiveness or superiority over inpatient management can be drawn.