Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries are complex injuries of the midfoot in which the optimal course of treatment remains controversial. The objective of this study was to identify whether open reduction and internal fixation (ORIF) was associated with greater risk for surgical complications and/or greater financial burden in comparison to a primary arthrodesis (PA). Methods: A retrospective database review was conducted using the PearlDiver database to identify all Medicare patients who underwent a Lisfranc ORIF or PA in an inpatient setting from 2006-2013. Exclusion criteria included age >85 years and a prior history of foot or ankle trauma/infection/malignancy within 5 years of index surgery. Patients were matched in a 1:1 statistical manner to precisely control for potential influence of comorbidities and demographics, resulting in two cohorts with 2746 patients in each. Perioperative complications (within 30 days) were compared between the cohorts, in addition to the respective costs associated with each procedure. Complications were broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) or minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Results: No significant differences in major perioperative complications were noted between the two procedures. Significant differences were however noted in the incidence of minor perioperative complications, including higher rates of hardware failure (OR 0.26 (CI 95%, 0.07-0.752, P=0.021) and transfusion (OR 0.37 (CI 95%, 0.13-0.94, P=0.045) in the ORIF cohort. There was additionally a higher incidence of 30 day readmission (OR 0.35 (CI 95%, 0.24-0.51, P<0.001) with ORIF. Length of hospital stay (LOS) was shorter in the PA cohort (x̅; = 2.59 days) compared to the ORIF cohort (x̅; = 5.58 days, p < 0.001). Higher mean total hospital costs were noted for ORIF (x̅ = $66,342.56) compared to PA (x̅ = $40,761.65, p < 0.001). Conclusion: Within our study population, ORIF has a significantly higher rate of hardware failure and transfusion, and 2.5 times the risk of readmission within 30 days. When comparing the total cost of care, there was a significantly greater cost with ORIF. LOS was also significantly longer in the ORIF group. One weakness of this study was the ability to account for patients <65, as these were pooled into a single age group by the database. While revealing with regard to the aforementioned variables, further research still needs to be conducted on the functional outcomes of these procedures. [Table: see text][Table: see text][Table: see text]
Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus is a very common deformity of the foot, often resulting from adult acquired flatfoot disorder (AAFD). This deformity in its early stages is treated conservatively with non-operatively modalities such as bracing, however in its later stages often requires surgical correction of the deformity in order to improve the pain and function of the extremity. Two commonly performed procedures in the correction of this type of deformity are a triple arthrodesis or joint sparing flatfoot reconstruction. The objective of this study was to identify whether differences existed in the financial burden or complication rates of non-fusion flatfoot reconstruction versus triple arthrodesis. Methods: The PearlDiver Database was queried from 2006-2013 to identify all Medicare patients who were admitted for a triple arthrodesis or non-fusion flatfoot reconstruction. 2308 patients were identified in each cohort and statistically matched in a 1:1 manner to control for influence of demographics and/or comorbidities. Postoperative complication rates (within 30 days) were evaluated and broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) and minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Additionally, total cost of care including cost of readmissions, and readmission within 30 days were evaluated. Results: No significant differences were noted in the postoperative complication rates between the two procedures within the first 30 days post-operatively in the initial univariate regression. There was a significant difference in the rate of 30 day readmission with 2.3% of triple arthrodeses being readmitted vs. 1.08% in the non-fusion joint reconstruction group (p=.002). Adjusted multivariate regression yielded similar results, with no significant differences in postoperative complication rates. The difference in readmission rate remained significant in the multivariate regression (OR 2.13, 95% CI 1.33-3.51, p=.002). Significant differences were also noted for mean total cost of care, with a higher mean total cost identified for the fusion group (x=7,868.0) compared to the reconstruction group (x=4,064.49, p<.001, Adjusted 𝛽𝛽 3,836.71, 95% CI 3,525.23 to 4,148.19, p<.001). Conclusion: This study compared triple arthrodesis versus joint-sparing flatfoot reconstruction. Within this study group there was no difference in complications between the two procedures. There was a significantly higher incidence of 30-day readmission in the triple arthrodesis group by about 2-fold. When comparing the total cost of care, there was a significantly higher cost associated with the triple arthrodesis, which cost on average about $3800 more than joint sparing flatfoot reconstruction. While revealing with regard to the aforementioned variables within the first 30 days post-operatively, further research needs to be conducted on the long term outcomes of these procedures. [Table: see text][Table: see text][Table: see text]
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.