Objective: Establish baseline rates of and risk factors for reoperation within 1 or 2 years of ankle open reduction internal fixation (ORIF).

Design: Retrospective, population based, cohort study.

Setting: 202 hospitals in Ontario, Canada (approximate population 13.6 million in 2014).

Patients/Participants: 45,444 patients that underwent ankle ORIF performed by 710 different surgeons between January 1, 1994 and December 31, 2011.

Main outcome measurements: Intermediate-term reoperation due to isolated implant removal, repeat ORIF, irrigation and debridement (I&D) due to infection, or amputation. Multivariable logistic regression related potential prognostic factors (patient, provider, and injury) to reoperation.

Results: There were 8,936 patients who underwent at least one subsequent operation (19.7%). The most common procedure was isolated implant removal (18.7%); odds of removal being higher for females (odds ratio [OR], 1.53; 95% confidence interval [CI], 1.45 - 1.62 p<0.001). N=674 patients (1.5%) underwent reoperation for another reason. The odds of repeat ORIF and I&D infection were greater for open fractures (OR 2.17; 95% CI, 1.22 - 3.86; p = 0.008 and OR 3.12; 95% CI 1.94 - 5.03; p < 0.001). Odds of amputation was highest for diabetics (OR 7.42; 95% CI 3.73 - 14.86; p < 0.001).

Conclusion: Isolated implant removal accounts for the vast majority of intermediate-term reoperations after ankle ORIF. Reoperation for other reasons (repeat ORIF, I&D, or amputation) was extremely rare, even among the highest risk patients. Concerns regarding reoperation for these reasons should not preclude operative treatment in any patient, provider or injury group we considered.

Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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