Lower all-cause 30-day mortality during summer following foot and ankle fracture surgery: a Swedish perioperative register-based study.

Background and purpose:  An important quality indicator of perioperative care is the all-cause 30-day mortality. Little is known about early mortality after foot and ankle fracture repair. We aimed to assess the all-cause 30-day mortality associated with surgical repair of foot and ankle fractures in Sweden during 2017-2022 and its seasonal variation.

Methods:  Foot and ankle fracture patients aged ≥ 18 years registered in the Swedish Perioperative Quality Register (SPOR) between 2017 and June 30, 2022 were included in the analysis (n = 26,404). Patient characteristics, perioperative observations, and early mortality were collected. Seasonal variation was analyzed for summer, autumn, winter, and spring. Perioperative mortality rate and odds ratio (OR) are reported with 95% confidence intervals (CI).

Results:  The all-cause 30-day mortality rate was 58 of the 26,404 studied patients (0.22%, CI 0.17-0.28). There was no change in mortality rate over the study period including the COVID-19 pandemic year. Increased adjusted odds ratio (OR) for 30-day mortality was seen among the elderly, age > 80 years, OR 22 (CI 9.2-50), and those with low health status, ASA class 3-4, OR 4.2 (CI 2.3-7.9), while surgery during summer was associated with a lower adjusted OR 0.4 (CI 0.1-0.9).

Conclusion: The all-cause 30-day mortality rate after foot and ankle fracture surgery in Sweden is reassuringly low with expected higher OR for mortality associated with age and health status, while surgery during summer months was associated with lower mortality.