{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:56:25Z","timestamp":1787507785148,"version":"build-2736575974"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T00:00:00Z","timestamp":1640908800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\n Introduction<\/jats:title>\n Ankle fractures have continued to occur through the COVID pandemic and, regardless of patient COVID status, often need operative intervention for optimizing long-term outcomes. For healthcare optimization, patient counseling, and care planning, understanding if COVID-positive patients undergoing ankle fracture surgery are at increased risk for perioperative adverse outcomes is of interest.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The COVID-19 Research Database contains recent United States aggregated insurance claims. Patients who underwent ankle fracture surgery from April 1st, 2020 to June 15th, 2020 were identified. COVID status was identified by ICD coding. Demographics, comorbidities, and postoperative complications were extracted based on administrative data. COVID-positive versus negative patients were compared with univariate analyses. Propensity-score matching was done on the basis of age, sex, and comorbidities. Multivariate regression was then performed to identify risk factors independently associated with the occurrence of 30-day postoperative adverse events.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In total, 9,835 patients undergoing ankle fracture surgery were identified, of which 57 (0.58%) were COVID-positive. COVID-positive ankle fracture patients demonstrated a higher prevalence of comorbidities, including: chronic kidney disease, diabetes, hypertension, and obesity (p<0.05 for each). After propensity matching and controlling for all preoperative variables, multivariate analysis found that COVID-positive patients were at increased risk of any adverse event (odds ratio [OR] = 3.89, p = 0.002), a serious adverse event (OR = 5.48, p = 0.002), and a minor adverse event (OR = 3.10, p = 0.021).<\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n COVID-positive patients will continue to present with ankle fractures requiring operative intervention. Even after propensity matching and controlling for patient factors, COVID-positive patients were found to be at increased risk of 30-day perioperative adverse events. Not only do treatment teams need to be protected from the transmission of COVID in such situations, but the increased incidence of perioperative adverse events needs to be considered.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0262115","type":"journal-article","created":{"date-parts":[[2021,12,31]],"date-time":"2021-12-31T13:44:31Z","timestamp":1640958271000},"page":"e0262115","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["COVID-positive ankle fracture patients are at increased odds of perioperative surgical complications following open reduction internal fixation surgery"],"prefix":"10.1371","volume":"16","author":[{"given":"Michael R.","family":"Mercier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anoop R.","family":"Galivanche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan P.","family":"Brand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Pathak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Medvecky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arya G.","family":"Varthi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee E.","family":"Rubin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2626-7278","authenticated-orcid":true,"given":"Jonathan N.","family":"Grauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,12,31]]},"reference":[{"key":"pone.0262115.ref001","first-page":"483","volume-title":"Miller\u2019s Review of Orthopaedics","author":"AR Kadiakia","year":"2016","edition":"7"},{"key":"pone.0262115.ref002","article-title":"SARS-CoV-2 seroprevalence in COVID-19 hotspots","author":"I Eckerle","year":"2020","journal-title":"The Lancet"},{"key":"pone.0262115.ref003","article-title":"Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: Retrospective case series.","author":"XW Xu","year":"2020","journal-title":"BMJ"},{"key":"pone.0262115.ref004","article-title":"Seroprevalence of SARS-CoV-2-Specific Antibodies among Adults in Los Angeles County, California, on April 10\u201311, 2020.","author":"N Sood","year":"2020","journal-title":"JAMA\u2014Journal of the American Medical Association"},{"key":"pone.0262115.ref005","article-title":"Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study.","author":"M Poll\u00e1n","year":"2020","journal-title":"Lancet"},{"key":"pone.0262115.ref006","article-title":"Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study.","author":"S Stringhini","year":"2020","journal-title":"Lancet"},{"key":"pone.0262115.ref007","article-title":"Epidemiology of ankle fractures in Rochester, minnesota.","author":"PJ Daly","year":"1987","journal-title":"Acta Orthop"},{"key":"pone.0262115.ref008","article-title":"Morbidity and Readmission After Open Reduction and Internal Fixation of Ankle Fractures Are Associated With Preoperative Patient Characteristics","author":"BA Basques","year":"2015","journal-title":"Clin Orthop Relat Res"},{"key":"pone.0262115.ref009","article-title":"Complication rates following open reduction and internal fixation of ankle fractures","author":"NF SooHoo","year":"2009","journal-title":"J Bone Jt Surg\u2014Ser A"},{"key":"pone.0262115.ref010","article-title":"Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study","author":"D Nepogodiev","year":"2020","journal-title":"Lancet"},{"key":"pone.0262115.ref011","article-title":"Database studies: An increasing trend in the United States orthopaedic literature.","author":"L Sivasundaram","year":"2016","journal-title":"Current Orthopaedic Practice"},{"key":"pone.0262115.ref012","article-title":"Database and registry research in orthopaedic surgery Part I: Claims-based data.","author":"AJ Pugely","year":"2014","journal-title":"J Bone Jt Surg\u2014Am Vol"},{"key":"pone.0262115.ref013","article-title":"Database and registry research in orthopaedic surgery: Part 2: Clinical registry data.","author":"AJ Pugely","year":"2014","journal-title":"J Bone Jt Surg\u2014Am Vol."},{"key":"pone.0262115.ref014","article-title":"Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? 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