A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty

Borenstein, Todd; Anand, Kapil; Li, Quan‐Lin; Charlton, Timothy P.; Thordarson, David B.

doi:10.1177/1071100717738748

Cited by 37 publications

(30 citation statements)

References 26 publications

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“…The patient was treated with I&D and intravenous antibiotics and the patient retained all components. Similarly, Borenstein et al 3 reported 1 ankle among 65 consecutive TAAs (1.5%) that experienced deep infection. The patient was treated with I&D and 6 weeks of intravenous antibiotics.…”

Section: Rationalementioning

confidence: 85%

What Is the Treatment “Algorithm” for an Infected Total Ankle Arthroplasty (TAA)?

2019

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Section: Rationalementioning

confidence: 85%

What Is the Treatment “Algorithm” for an Infected Total Ankle Arthroplasty (TAA)?

2019

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“…These complications included one (1.5%) minor wound dehiscence, one (1.5%) wound infection, two (3%) revision surgeries, and eight (12%) non-revision surgeries. This study demonstrated that outpatient TAA is a safe and beneficial choice in appropriately selected patients [8].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have demonstrated the safety and reduced costs of common orthopedic surgeries, including primary shoulder arthroplasty, hip arthroplasty, and knee arthroplasty, performed in the outpatient setting in selected patients [5-7]. Furthermore, there is evidence supporting the safety of outpatient total ankle arthroplasty and surgery for closed ankle fractures [8-10]. Although the literature shows promising trends of safety in areas of outpatient orthopedic surgeries, it lacks any large database studies evaluating common elective foot and ankle surgeries.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Inpatient Versus Outpatient Elective Foot and Ankle Surgery

Huntley

McGee

Johnson

et al. 2019

Cureus

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Background Complications following orthopedic surgeries are undesirable and costly. A potential method to reduce these costs is to perform traditionally inpatient surgical procedures in the outpatient setting. The purpose of this study is to compare outcomes between inpatient and outpatient settings for elective foot and ankle surgeries using the National Surgical Quality Improvement Program (NSQIP) database. Methods Patients with Current Procedural Terminology (CPT) codes specific to orthopedic foot and ankle surgery were identified from the 2011-2015 American College of Surgeons NSQIP database. Demographics, comorbidities, and complications were compared between patients undergoing inpatient and outpatient procedures. Results Patients receiving inpatient surgery were significantly older and more frequently male. Black patients were significantly more likely to undergo inpatient surgery than outpatient surgery while white patients were significantly more likely to undergo outpatient surgery. Outpatients had a significantly higher mean body mass index (BMI) than inpatients. Smokers were at a significantly greater risk of undergoing inpatient surgery than outpatient surgery. Outpatients had significantly longer operative times, were more likely to receive general anesthesia, had a lower American Society of Anesthesiologists (ASA) class, were more likely to be functionally independent, and were less likely to expire postoperatively. Patients who received surgery as an inpatient were significantly more likely to have comorbidities as compared to outpatients. The overall risk of surgical complications was significant between groups with 8.6% in the inpatient group and 2.0% in the outpatient group. The overall risk of medical complications was 16.9% in the inpatient group and 1.7% in the outpatient group. Similar to the surgical complications, inpatients were significantly more likely to sustain each of the individual medical complications except for stroke/CVA and venous thromboembolism. Conclusions Outpatient management is associated with decreased postoperative complications in select patients. Performing more operations in the outpatient setting in select patients may be beneficial for cost reduction and patient satisfaction.

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“…Although shorter hospital stays have been investigated for hip and knee arthroplasty, the same cannot be said for TAA, which presents its own unique challenges. Three separate studies have described outpatient TAA with excellent short-term outcomes and minimal complications [ 20 – 22 ]. However, these studies all shared the limitation of a small sample size ( N < 100), making it difficult to quantify short-term outcomes, particularly rare complications.…”

Section: Introductionmentioning

confidence: 99%

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

2020

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Background: Given the trend toward value-based care, there has been increased interest in minimizing hospital length of stay (LOS) after orthopedic procedures. Outpatient total ankle arthroplasty (TAA) has become more popular in recent years; however, research on surgical outcomes of this procedure has been limited. This study sought to employ large sample, propensity score-matched analyses to assess the safety of outpatient and short-stay discharge pathways following TAA. Methods: The ACS NSQIP database was used to identify 1141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to match patients based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities. The incidence of various 30-day complications was compared between the short and standard LOS groups to assess for any differences in short-term outcomes. Results: A total of 892 patients were included in the final propensity score-matched analysis, with 446 patients in each group. The short LOS group had a significantly lower rate of medical complications (0.2% vs. 2.5%, p = 0.006) and non-home discharge (1.3% vs. 12.1%, p < 0.001). There was no significant difference in operative complications (0.4% vs. 1.8%, p = 0.107), unplanned readmission (0.4% vs. 1.1%, p = 0.451), reoperation (0.2% vs. 0.4%, p > 0.999), return to the OR (0.2% vs. 0.9%, p = 0.374), or mortality (0.7% vs. 0.0%, p > 0.249) between the short and standard LOS groups. Conclusions: Outpatient and short-stay hospitalization had comparable safety to standard inpatient hospitalization after TAA. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications.

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A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty

Abstract: Level IV, retrospective case series.

Cited by 37 publications

References 26 publications

What Is the Treatment “Algorithm” for an Infected Total Ankle Arthroplasty (TAA)?

What Is the Treatment “Algorithm” for an Infected Total Ankle Arthroplasty (TAA)?

Outcomes of Inpatient Versus Outpatient Elective Foot and Ankle Surgery

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

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