A propensity score-matched analysis comparing outpatient and short-stay hospitalization to standard inpatient hospitalization following total ankle arthroplasty

Plantz, Mark A.; Sherman, Alain E.; Kadakia, Anish R.

doi:10.1186/s13018-020-01793-5

Cited by 21 publications

(18 citation statements)

References 36 publications

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“…While reasons for a prolonged hospital stay are certainly numerous, prior literature has demonstrated a clear association between increased length of stay and suboptimal outcomes following TAA. 14,15 Our data contributes to a mixed body of literature on race and its effect on hospitalization length after TAA. In a study utilizing the NIS (National Inpatient Sample) database, Singh and Cleveland reported a significantly higher rate of prolonged hospital stays in black and Hispanic TAA patients compared to white patients.…”

Section: Discussionmentioning

confidence: 78%

Short-Term Complications Following Total Ankle Arthroplasty and Associated Risk Factors: A NSQIP Database Analysis

Kwon

Danilkowicz

Kim

et al. 2022

Foot & Ankle Specialist

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Introduction Total ankle arthroplasty (TAA) has become increasingly utilized over the past 20 years to treat osteoarthritis of the ankle. The efficacy and safety of this procedure has been previously reported, but relatively few studies have documented the risk of postoperative complications associated with TAA over the past 10 years. Thus, the aim of this study is to provide a current report on the safety of TAA, particularly in association with a number of preoperative risk factors. Methods A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent TAA between 2012 and 2018 was performed. A total of 1333 patients were included in this analysis. Penalized logistic regression to consider small numbers of the postoperative complications was used to identify factors associated with incidence of the complications. Results The rate of readmission and superficial wound infection were found to be 1.4% and 0.6%, respectively. Risk factors associated with a prolonged hospital stay were black race, Hispanic race, and smoking. Diabetes was associated with a significantly increased risk of readmission. Age, sex, body mass index, and steroid use were not associated with increased risk of postoperative complications. Conclusion In this study, the rate of surgical site infection and readmission in TAA was found to be relatively low, compared to published data on total knee arthroplasty and total hip arthroplasty. Both race and smoking increase the risk of prolonged hospital stay, while diabetes increases the risk of readmission. Levels of Evidence: Level III, retrospective comparative trial.

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Section: Discussionmentioning

confidence: 78%

Short-Term Complications Following Total Ankle Arthroplasty and Associated Risk Factors: A NSQIP Database Analysis

Kwon

Danilkowicz

Kim

et al. 2022

Foot & Ankle Specialist

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“…There is, howevera lack of evidence around other major procedures such as ankle fusions being performed as day-case. The safety of outpatient compared with inpatient ankle surgery is comparable and therefore they suggest that outpatient ankle surgeries should be considered for patients that are suitable[ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons

Berry¹,

Houchen–Wolloff²,

Crane³

et al. 2023

World J Orthop

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BACKGROUND Advances in minimally invasive surgery and improved post-operative pain management make it possible to consider performing even major foot/ankle operations as day-case. This could have significant benefits for patients and the health service. However there are theoretical concerns about post-operative complications and patient satisfaction due to pain. AIM To scope the current practice of foot and ankle surgeons on day-case surgery for major foot and ankle procedures in the United Kingdom (UK). METHODS An online survey (19 questions) was sent to UK foot and ankle surgeons via the British Orthopaedic Foot & Ankle Society membership list in August 2021. Major foot and ankle procedures were defined as surgery that is usually performed as an inpatient in majority of centres and day-case as same day discharge, with day surgery as the intended treatment pathway. RESULTS 132 people responded to the survey invitation with 80% working in Acute NHS Trusts. Currently 45% of respondents perform less than 100 day-case surgeries per year for these procedures. 78% felt that there was scope to perform more procedures as day-case at their centre. Post-operative pain (34%) and patient satisfaction (10%) was not highly measured within their centres. Lack of adequate physiotherapy input pre/post-operatively (23%) and lack of out of hours support (21%) were the top perceived barriers to performing more major foot and ankle procedures as day-case. CONCLUSION There is consensus among UK surgeons to do more major foot/ankle procedures as day-case. Out of hours support and physiotherapy input pre/ post-op were perceived as the main barriers. Despite theoretical concerns about post-operative pain and satisfaction this was only measured by a third of those surveyed. There is a need for nationally agreed protocols to optimise the delivery of and measurement of outcomes in this type of surgery. At a local level, the provision of physiotherapy and out of hours support should be explored at sites where this is a perceived barrier.

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“… 26 Another investigation indicated that outpatient and short-stay discharge do not inherently increase the incidence of short-term complications and poor outcomes relative to standard inpatient hospitalization after TAA. 20 Neither of these studies evaluated the factors predictive of early complications. The present study indicates outpatient TAA is not associated with increased risk of complications, reoperation, or readmission, which reinforces previous findings.…”

Section: Discussionmentioning

confidence: 99%

“…The present study indicates outpatient TAA is not associated with increased risk of complications, reoperation, or readmission, which reinforces previous findings. 20 , 26 The finding of increased 30-day readmission in patients undergoing TAA as an inpatient prompted evaluation of factors predictive of complications, reoperation, and readmission. These results will serve to guide patient selection for TAA and performance of this procedure on an outpatient basis.…”

Section: Discussionmentioning

confidence: 99%

Factors Predictive of Early Complications Following Total Ankle Arthroplasty

Balso

Halai

MacLeod

et al. 2022

Foot & Ankle Orthopaedics

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Background: The safety of outpatient total ankle arthroplasty (TAA), and factors predictive of early complications are poorly understood. The objective of this study was to determine the frequency of early complications in patients undergoing outpatient TAA compared to a matched inpatient TAA cohort. Factors predictive of early complications following TAA are elucidated. Methods: A retrospective review of prospectively collected data from the 2011-2018 American College of Surgeons–National Surgical Quality Improvement Program (ACS-NSQIP) database was performed. An unadjusted analysis comparing complication rates in outpatient, and inpatient TAA was performed followed by a propensity score–matched cohort analysis. A multivariate logistic regression model was then used to identify significant independent predictors for complications, reoperation, and readmission following TAA. Results: A total of 1487 patients (198 outpatient, 1289 inpatient) undergoing TAA were included in the study. Inpatient TAA was associated with increased 30-day readmission compared with outpatient TAA (3.54% vs 0.51%, P = .032) in a matched cohort analysis. Thirty-eight (2.6%) patients had a minor complication, with 16 (1.1%) patients having a major complication after TAR. Nineteen (1.3%) patients underwent reoperation, and 42 (2.8%) patients were readmitted within 30 days of the index TAR. Multivariate analysis identified factors predictive of early complications to include length of stay (LOS) >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus. Conclusion: From this relatively limited data set, outpatient TAA appears to be safe for management of end-stage ankle arthritis in select patients. Inpatient status was associated with an increased rate of 30-day readmission following TAA. Postoperative length of stay >2 days, smoking, hypertension, bleeding disorders, and diabetes mellitus were identified to be associated with early postoperative complications following TAA in this cohort. Level of Evidence Level III, retrospective cohort study.

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A propensity score-matched analysis comparing outpatient and short-stay hospitalization to standard inpatient hospitalization following total ankle arthroplasty

Cited by 21 publications

References 36 publications

Short-Term Complications Following Total Ankle Arthroplasty and Associated Risk Factors: A NSQIP Database Analysis

Short-Term Complications Following Total Ankle Arthroplasty and Associated Risk Factors: A NSQIP Database Analysis

Perceived barriers and facilitators of day-case surgery for major foot and ankle procedures? A cross-sectional survey of United Kingdom surgeons

Factors Predictive of Early Complications Following Total Ankle Arthroplasty

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