Ankle surgery has largely shifted to an outpatient setting due to advances in surgical and anesthetic techniques. For the majority of routine cases, ankle surgery is now an outpatient procedure. An outpatient procedure means the patient is admitted for surgery, recovers for a few hours, and is discharged home the same day. This same-day discharge is possible because minimally invasive methods decrease tissue trauma and simplify pain management, allowing for a safer and more comfortable recovery outside the hospital.
Ankle Procedures Commonly Performed Outpatient
Minimally invasive techniques have made a wide range of ankle operations suitable for same-day discharge. Ankle arthroscopy, often referred to as “keyhole surgery,” is the most common outpatient ankle procedure. This involves the surgeon inserting a tiny camera and instruments through small incisions to address issues inside the joint. This technique is used to treat conditions such as cartilage damage, bone spurs, impingement, and to remove loose bone or tissue fragments. Because the incisions are small, patients experience less postoperative pain and a faster initial recovery compared to traditional open surgery.
Other common procedures performed without an overnight stay include certain ligament and tendon repairs. Lateral ankle ligament reconstruction, such as the Broström procedure, is typically an outpatient surgery to correct chronic instability. Simple fracture fixation, particularly for non-displaced breaks, can also be managed in an outpatient setting. These procedures are conducive to same-day discharge because they are completed quickly, and localized pain control methods, like nerve blocks, offer extended pain relief.
Determining Factors for an Overnight Stay
While many ankle surgeries are performed on an outpatient basis, certain procedure complexities or patient health conditions may necessitate an overnight stay for monitoring. Major reconstructive surgeries, such as total ankle replacement (arthroplasty) or ankle fusion (arthrodesis) for severe arthritis, often require hospitalization due to their invasiveness and the need for intense post-operative pain control. Similarly, the fixation of complex ankle fractures, especially those that involve multiple bone fragments or significant dislocation, may warrant a longer stay to manage swelling and monitor for complications like compartment syndrome.
A patient’s overall health status is a primary factor for inpatient admission, regardless of the procedure type. Patients with significant pre-existing medical conditions, known as comorbidities, face a higher risk of complications following general anesthesia and surgery. Examples include severe cardiovascular disease, uncontrolled diabetes, or chronic respiratory issues. The American Society of Anesthesiologists (ASA) physical status classification is often used to assess this risk. Constant monitoring available in a hospital setting is considered safer for these individuals to stabilize existing conditions in the immediate post-operative period.
Social factors can also influence the discharge decision, even for a technically simple procedure. If a patient lacks adequate support at home, such as a responsible adult caregiver for the first 24 hours, an overnight admission may be arranged. This also applies if their living environment is unsafe or unsuitable for non-weight-bearing recovery. The decision to keep a patient overnight is individualized, based on a comprehensive risk assessment that weighs the complexity of the operation against the patient’s medical and social circumstances.
The Immediate Outpatient Discharge Process
Following a successful outpatient ankle surgery, the patient is transferred to the Post-Anesthesia Care Unit (PACU) for the first phase of recovery. In the PACU, nurses closely monitor vital signs, including heart rate, blood pressure, and oxygen saturation, to ensure the patient is safely emerging from anesthesia. The initial management of pain relies on the regional nerve block placed before surgery, which can provide pain relief for up to 24 hours.
For a patient to be cleared for same-day discharge, they must meet specific, rigorous criteria. They must be fully awake and oriented, have stable vital signs, and demonstrate adequate control of their pain using oral pain medication, anticipating the nerve block wearing off. Patients are also assessed for their ability to tolerate oral fluids and must not be experiencing excessive nausea or vomiting.
A physical therapist or nurse instructs the patient on the use of crutches or a walker. The patient must be able to safely ambulate, even if it is non-weight-bearing. The final step involves providing detailed instructions on wound care, managing swelling through elevation, and administering prescribed pain medication. A responsible adult must drive the patient home and remain with them for the first 24 hours, as anesthesia effects make driving unsafe.