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

Kwon, Nicholas F.; Danilkowicz, Richard; Kim, Jaewhan; Grimm, Nathan L.; Adams, Samuel B.

doi:10.1177/19386400211072379

Cited by 10 publications

(3 citation statements)

References 31 publications

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“…Short-and longer-term outcomes of TAR have been reported. 1,3,16,18,21,25,46 Overall, TAR has been shown to be a safe procedure, with good long-term outcomes. 5 However, the current study demonstrates that 8.4% of a large cohort of patients undergoing TAR visited the ED at least once during the 90-day postoperative period, with almost a quarter of those visiting the ED more than once.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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Background: Total ankle replacement (TAR) utilization in the United States has steeply increased in recent decades. Emergency department (ED) visits following TAR impacts patient satisfaction and health care costs and warrant exploration. Methods: This retrospective cohort study utilized the 2010 to 2019 M91Ortho PearlDiver data set to identify TAR patients with at least 90 days of follow-up. PearlDiver contains billing claims data across all sites of care throughout the United States for all indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), region of the country in which surgery was performed, insurance plan, and postoperative hospital length of stay. Ninety-day postoperative ED visit incidence, timing, frequency, and primary diagnoses were identified and compared to 1-year postoperative ED visit baseline data. Univariate and multivariate logistic regression analyses were used to determine risk factors for ED visits. Results: Of 5930 TAR patients identified, ED visits within 90 days were noted for 497 (8.4%) patients. Of all ED visits, 32.0% occurred within 2 weeks following surgery. Multivariate analysis revealed several predictors of ED utilization: younger age (odds ratio [OR] 1.35 per decade decrease), female sex (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed in the western US (OR 1.34), and Medicaid coverage (OR 2.70; 1.71-4.22 relative to Medicare) ( P < .05 each). Surgical site issues comprised 78.0% of ED visits, with surgical site pain (57.0%) as the most common problem. Conclusion: Of 5930 TAR patients, 8.4% returned to the ED within 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was in the first 2 postoperative weeks, and surgical site pain was the most common reason. Pain management pathways following TAR should be able to be adjusted to minimize the occurrence of postoperative ED visits, thereby improving patient experiences and decreasing health care utilization/costs. Level of Evidence: Level III, retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Ratnasamy

Kammien

Gouzoulis

et al. 2022

Foot & Ankle Orthopaedics

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“…As a result, 9 studies with a total of 10 388 patients were eligible for inclusion in the quantitative analysis [6][7][8]15,16,26,53,62,64 and 28 in the narrative synthesis. [1][2][3][4][5][9][10][11]13,14,[17][18][19]23,25,29,[34][35][36]40,44,47,48,50,51,56,59,65…”

Section: Search and Selectionmentioning

confidence: 99%

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

Varga,

Váncsa,

Agócs

et al. 2023

Foot Ankle Int.

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Background: The increasing number of total ankle arthroplasties (TAAs) has led to growing evidence on the risk factors for complications after surgery. However, the role of obesity in this patient group has been the subject of much debate. Therefore, this systematic review aimed to investigate the evidence for untoward effects of obesity following TAA. Methods: We conducted a comprehensive search on April 28, 2023, in MEDLINE (via PubMed), Embase, and CENTRAL. Eligible observational studies reported on the short- and long-term outcomes of primary TAA, comparing patients with and without obesity (defined as body mass index > 30). Using a random effects model, we calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs) from 2 by 2 tables (event and nonevent in the obese and nonobese primary TAA groups). Results: Nine studies with 10 388 patients were eligible for inclusion in the meta-analysis. We found significantly higher odds of revision in the obese group compared to the nonobese group (OR = 1.68, CI: 1.44-1.95). However, the odds of overall perioperative complications (OR = 1.55, CI: 0.50-4.80) and wound complications (OR = 1.34, CI: 0.29-6.20) were nonsignificantly higher in the obese group. Conclusion: Based on our results, obesity may have affected long-term outcomes following TAA and may have negatively affected the prosthesis’s survival.

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“…Regarding the smoking status, Known et al (15) published the first data showing an association between smoking and prolonged hospitalization after TAR. Whalen et al (8) studied 57 consecutive total ankle arthroplasties with a wound complication rate of 28%.…”

mentioning

confidence: 99%

Intramedullary nailing as osteosynthesis technique for the fibula in total ankle arthroplasty via lateral approach

Carrasco,

Dorado,

Martínez

et al. 2024

J Foot Ankle

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Objective: To describe a variation in the final osteosynthesis technique for total ankle replacement (TAR) implantation through lateralapproach. Methods: We retrospectively reviewed a series of cases dated between January 2022 and May 2023 in which intramedullary nailing was used as the osteosynthesis technique for the fibula during TAR implantation via lateral approach. Results: In all cases, skin scarring and soft tissue recovery to baseline were achieved in one and a half month to three months. Consolidation of the fibula occurred at an average of three months. No material was removed in any of the cases to date. Finally, patients were satisfied, resuming their previous activities. Conclusion: To our knowledge, this study is the first to investigate a modification of the osteosynthesis technique in the lateral approach to TAR. We believe the intramedullary nail for the fibula may be a useful tool to prevent soft tissue complications, requiring prospective and comparative studies to evaluate its efficacy. Level of Evidence IV; Therapeutic Studies; Case Series.

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

Cited by 10 publications

References 31 publications

Emergency Department Visits Within 90 Days of Total Ankle Replacement

Emergency Department Visits Within 90 Days of Total Ankle Replacement

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

Intramedullary nailing as osteosynthesis technique for the fibula in total ankle arthroplasty via lateral approach

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