# Navigating Ankle Fracture Surgery in the Shadow of COVID-19

## TL;DR

This study examined whether having COVID-19 before ankle surgery increases postoperative complications, finding limited significant effects.

## Contribution

The study contributes a case-control analysis of ankle fracture surgery outcomes in the context of recent preoperative COVID-19 diagnosis.

## Key findings

- Patients with recent preoperative COVID-19 had slightly higher BMI but no significant increase in most postoperative complications.
- A higher risk of 30-day mortality was observed for patients with COVID-19 diagnosed within 0 to 2 weeks of surgery.
- Overall, preoperative COVID-19 was not significantly associated with most postoperative complications.

## Abstract

This case control study aimed to evaluate the impact of preoperative COVID-19 diagnosis on postoperative complications in patients undergoing ankle fracture surgery using the National COVID-19 Cohort Collaborative (N3C) database. The investigation focused on the interplay between COVID-19 diagnosis timing, patient characteristics, and clinical outcomes, particularly considering the potential mechanisms by which COVID-19 may contribute to increased complications.

This case control study included patients who underwent ankle fracture surgery using the N3C database. The cohort was divided into two groups: patients without COVID-19 diagnosis within 12 weeks of surgery (n = 16 806) and those with a positive COVID-19 diagnosis within 12 weeks of surgery (n = 369). Demographic factors were analyzed. Clinical outcomes encompassed deep vein thrombosis (DVT), sepsis, surgical site infection, bleeding, acute kidney injury, 30-day mortality, and 365-day mortality. Multivariate logistic regression analyses were conducted.

The COVID-19–positive cohort displayed a slightly higher mean age (52.95 ± 18.43 vs 51.62 ± 18.36, P = .169) and body mass index (34.88 ± 9.99 vs 33.86 ± 8.80, P = .028) compared to the negative cohort. Although some outcomes, such as DVT and sepsis, demonstrated slightly higher frequencies in the COVID-19–positive group, these differences were not statistically significant. Adjusted odds ratios (AORs) for various COVID-19 diagnosis periods were generally not significant, except for a heightened risk of 30-day all-cause mortality associated with COVID-19 positivity within 0 to 2 weeks of surgery (AOR = 6.29, P = .003).

Preoperative COVID-19 diagnosis within 12 weeks did not exhibit a significant association with most postoperative complications. While this study did not unveil substantial COVID-19–related effects, acknowledging the broader context of the pandemic remains essential in guiding comprehensive patient care strategies.

Level III