Low early perioperative complication, seen after total ankle arthroplasty

Recently published data indicated total ankle arthroplasty is a relatively safe surgery with an overall 30-day complication rate of 1.4% and mortality of less than 1%.

“Patients who are male, have a history of community-acquired pneumonia and have a larger number of preoperative comorbidities had a significantly increased risk of developing one complication within 30 days of [total ankle arthroplasty] TAA,” Xinning Li, MD, assistant professor of the Department of Sports Medicine and Shoulder Surgery and team physician at Boston University, told Orthopedics Today.

Increase in surgeries performed

Using the University HealthSystems Consortium administrative database, Li and his colleagues retrospectively identified 2,340 adult patients who underwent total ankle arthroplasty (TAA) between 2007 and 2011. Patient age was an average of 62.5 years, and there was nearly an even ratio of male to female patients. Patient demographics, hospital length of stay, hospital direct cost, in-hospital mortality and 30-day readmission rates were analyzed. Predictive preoperative factors for increased risk of 30-day complications were determined by univariate regression analysis.

The average length of hospital stay was 2.2 days. Following the hospital stay, 88.5% of patients were discharged to home. Overall, 2.7% of patients were readmitted within the first 30 days following discharge. Complications after discharge included deep vein thrombosis (2.3%), reoperation (0.7%) and infection (3.2%). The average total direct cost per case was $16,212. Li said he was surprised by how low both the overall inpatient and 30-day complications rates were after the surgeries were performed.

According to univariate regression analysis results, male patients, patients with a history of community-acquired pneumonia and patients with more preoperative comorbidities had significantly higher chances of developing one comorbidity within 30 days of arthroplasty.

Li also noted the number of TAAs performed in the United States had more than doubled (from 290 to 632) between 2007 to 2011 and the majority of academic centers in the United States (73 of 95) performed less than 10 TAAs during the study time period. Only 6 centers performed more than 100 cases in that span.

Study limitations, future research

“We used a readily available database for the study, so our conclusions were constrained by the available data and subject to selection, detection and reporting bias,” he said.

According to Li, the study could not be expanded to other countries because they used databases specifically from academic centers in the United States.

Li and his colleagues did not know the type of device used, surgeons’ level of experience, indications for surgery, reasons for readmission, outcomes or long-term complications.

“We are also unable to conclude whether the increasing trend of number of TAAs performed is due to increased number of patients with ankle arthritis, increase in the number of Fellowship-trained foot and ankle surgeons who are comfortable in doing total ankle replacements or due to advancements in technology,” he said.

Li added future research would address the study limitations through a retrospective study to evaluate the long-term outcomes and complications. – by Monica Jaramillo

Disclosure: Li reports no relevant financial disclosures.

Recently published data indicated total ankle arthroplasty is a relatively safe surgery with an overall 30-day complication rate of 1.4% and mortality of less than 1%.

“Patients who are male, have a history of community-acquired pneumonia and have a larger number of preoperative comorbidities had a significantly increased risk of developing one complication within 30 days of [total ankle arthroplasty] TAA,” Xinning Li, MD, assistant professor of the Department of Sports Medicine and Shoulder Surgery and team physician at Boston University, told Orthopedics Today.

Increase in surgeries performed

Using the University HealthSystems Consortium administrative database, Li and his colleagues retrospectively identified 2,340 adult patients who underwent total ankle arthroplasty (TAA) between 2007 and 2011. Patient age was an average of 62.5 years, and there was nearly an even ratio of male to female patients. Patient demographics, hospital length of stay, hospital direct cost, in-hospital mortality and 30-day readmission rates were analyzed. Predictive preoperative factors for increased risk of 30-day complications were determined by univariate regression analysis.

The average length of hospital stay was 2.2 days. Following the hospital stay, 88.5% of patients were discharged to home. Overall, 2.7% of patients were readmitted within the first 30 days following discharge. Complications after discharge included deep vein thrombosis (2.3%), reoperation (0.7%) and infection (3.2%). The average total direct cost per case was $16,212. Li said he was surprised by how low both the overall inpatient and 30-day complications rates were after the surgeries were performed.

According to univariate regression analysis results, male patients, patients with a history of community-acquired pneumonia and patients with more preoperative comorbidities had significantly higher chances of developing one comorbidity within 30 days of arthroplasty.

Li also noted the number of TAAs performed in the United States had more than doubled (from 290 to 632) between 2007 to 2011 and the majority of academic centers in the United States (73 of 95) performed less than 10 TAAs during the study time period. Only 6 centers performed more than 100 cases in that span.

Study limitations, future research

“We used a readily available database for the study, so our conclusions were constrained by the available data and subject to selection, detection and reporting bias,” he said.

According to Li, the study could not be expanded to other countries because they used databases specifically from academic centers in the United States.

Li and his colleagues did not know the type of device used, surgeons’ level of experience, indications for surgery, reasons for readmission, outcomes or long-term complications.

“We are also unable to conclude whether the increasing trend of number of TAAs performed is due to increased number of patients with ankle arthritis, increase in the number of Fellowship-trained foot and ankle surgeons who are comfortable in doing total ankle replacements or due to advancements in technology,” he said.

Li added future research would address the study limitations through a retrospective study to evaluate the long-term outcomes and complications. – by Monica Jaramillo

Disclosure: Li reports no relevant financial disclosures.