Factors Predictive of Early Complications Following Total Ankle Arthroplasty

Abstract

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.

Safety of Same-Day Discharge Following Total Ankle Arthroplasty: A Retrospective Cohort Analysis

“…Prior studies have similarly found baseline differences in patients undergoing outpatient and inpatient TAA. 1 , 6 , 22 , 28 Previous studies have shown increased complication and revision rates in TAA in patients with obesity and diabetes. 10 , 25 We did not observe a difference in BMI or in diabetes prevalence at baseline between the same-day discharge TAA group and the inpatient TAA group, suggesting that these factors are not of high importance in determining patient selection for same-day discharge at our institution.…”

Obesity and Ankle Prosthesis Revision: A Systematic Review and Meta-analysis

“…For example, type 2 diabetes and smoking are known risk factors for TAA. 12,21,54 However, the role of excess weight or obesity as a prognostic factor for TAA is still under debate. 20,31,33,37…”

“…For example, type 2 diabetes and smoking are known risk factors for TAA. 12,21,54 However, the role of excess weight or obesity as a prognostic factor for TAA is still under debate. 20,31,33,37 In orthopaedic clinical practice, body weight is a crucial criterion in patient selection since the negative effect of higher body mass index (BMI) on hip and knee arthroplasty outcomes is proven.…”