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Is There a Need for an Integrated Orthoplastic Approach to Extremity Trauma Management? Before You know Where You're Going, You Need to Know Where You Are…
Molly Meeker, BS, Gunel Guliyeva, MD, Benjamin Ormseth, BS, Fielding Fischer, BS, Jason M. Souza, MD, FACS
Ohio State College of Medicine
2023-02-01
Presenter: Molly Meeker
Affidavit:
Jason M. Souza
The student contributed to more than 50% of the original work.
Director Name: Jason M. Souza
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background: An integrated orthoplastic approach to limb salvage aims to optimize efficiency and improve surgical outcomes by applying the principles and practice of orthopedic and plastic surgery simultaneously. However, a truly integrated approach requires coordination between services and a perceived increased utilization of operative and inpatient resources. To determine the potential benefit of an integrated orthoplastic approach, we first aimed to define efficiency metrics associated with the conventional approach previously employed at our institution.
Materials and Methods: ICD10 codes were used to identify patients treated for open tibial/ankle fractures between 2018-2022 at OSUWMC. Retrospective data characterizing the nature, timing, and clinical outcomes associated with the surgical treatment of patients with open tibial and ankle fractures were abstracted.
Results: 25 of 105 patients with open fractures required soft tissue coverage. Compared to patients who did not require soft tissue intervention, this group experienced more (84% vs. 29%, P<.001) complications and required more outpatient wound care (48% vs.15%, P<.001). The average number of surgeries, admissions, and length of stay were also higher (8.08 vs. 2.25; 3.4 vs. 1.5; and 39.58 vs. 11.98 days, P<.001) for them. Strikingly, almost 2/3 of the surgeries (5.03/8.08 surgeries) and hospital stay (26.65/39.58 days) occurred after the discharge from the initial admission. On average, soft tissue intervention was performed after 4.32 surgeries and 28.96 days.
Conclusion: This study has identified gaps in patient outcomes and inefficiencies in care delivery that may be addressed by implementing an integrated orthoplastic approach to extremity trauma management.
