The Safety Profile of Same-Day Outpatient Total Ankle Arthroplasty

Langan, Travis M.; Rushing, Calvin J.; McKenna, Bryon; Berlet, Gregory C.; Hyer, Christopher F.

doi:10.1053/j.jfas.2021.07.003

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…5,6,22,24 There is growing evidence that TAA can be safely performed as an outpatient procedure. 4,9,16,18,19,21,23,25 These studies have found similar rates of complications, including wound breakdown, infection, revision, and nonrevision procedures. Some studies have also examined postoperative medical complications, emergency department (ED) visits, and readmissions, without finding an increased incidence of complications for outpatient TAA.…”

Section: Introductionmentioning

confidence: 85%

Outpatient Total Ankle Arthroplasty (TAA) as a Rising Alternative to Inpatient TAA: A Database Analysis

Wolfe,

Demetracopoulos,

Ellis

et al. 2023

Foot Ankle Int.

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Background: There is growing evidence that total ankle arthroplasty (TAA) can safely be performed as an outpatient procedure, with the benefit of decreased health care expenses and improved patient satisfaction. The purpose of our study was to compare readmissions, arthroplasty failures, infections, and annual trends between outpatient and inpatient TAA using a large publicly available for-fee database. Methods: The PearlDiver Database was queried to identify outpatient and inpatient TAA-associated claims for several payer types from January 2010 to October 2021. Preoperative patient characteristics and annual trends were compared for inpatient and outpatient TAA. International Classification of Diseases, Ninth and Tenth Revision, diagnosis codes were used to identify infections and arthroplasty failures. Complications rates were compared after matching patients by age, gender, and the following comorbidities: diabetes, smoking, congestive heart failure (CHF), hypertension (HTN), obesity, and chronic kidney disease (CKD). Results: A total of 12 274 patients were included in the final exact-matched analysis for complications, with 6137 patients in each group. Outpatients had a significantly lower rate of readmission within 90 days (2.6% vs 4.0%, P < .001), arthroplasty failure (4.1% vs 6.9%, P < .001), and infection (2.4% vs 3.1%, P = .015). Among database enrollees, outpatient TAA has risen in proportion to inpatient TAA from 2019 to 2021. Conclusion: Outpatient TAA had lower rates of risk-adjusted readmission, arthroplasty failure, and infection compared to inpatient TAA. Level of Evidence: Level III, retrospective comparative database study.

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Section: Introductionmentioning

confidence: 85%

Outpatient Total Ankle Arthroplasty (TAA) as a Rising Alternative to Inpatient TAA: A Database Analysis

Wolfe,

Demetracopoulos,

Ellis

et al. 2023

Foot Ankle Int.

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“…If equally safe, the transition to same-day surgery has the potential to ensure patient satisfaction and decrease costs. 2 , 14 , 17 , 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

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

Wolfe,

Conti,

Henry

et al. 2024

Foot & Ankle Orthopaedics

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Background: Joint replacement procedures have traditionally been performed in an inpatient setting to minimize complication rates. There is growing evidence that total ankle arthroplasty (TAA) can safely be performed as an outpatient procedure, with the potential benefits of decreased health care expenses and improved patient satisfaction. Prior studies have not reliably made a distinction between outpatient TAA defined as length of stay <1 day and same-day discharge. The purpose of our study was to compare a large volume of same-day discharge and inpatient TAA for safety and efficacy. Methods: Patients undergoing TAA at our US-based institution are part of an institutional review board–approved registry. We queried the registry for TAA performed by the single highest-volume surgeon at our institution between May 2020 and March 2022. Same-day discharge TAA was defined as discharge on the day of the procedure. Patient demographics, baseline clinical variables, concomitant procedures, postoperative complications, and patient-reported outcomes were collected. Postoperative outcomes were compared after 1:1 nearest-neighbor matching by age, sex, Charlson Comorbidity Index (CCI), and American Society of Anesthesiologists (ASA) score. Multivariable models were created for comparison with the matched cohort outcome comparison analysis. Results: Our same-day discharge group was younger (median 58 vs 67 years; P < .001), with proportionally fewer females (36.4% vs 51.4%; P = .044) and lower Charlson Comorbidity Indices (median 1 vs 3; P < .001) than the inpatient group. At a median follow-up of 1 year, after matching by age, sex, CCI, and ASA score, there was no difference in complications ( P = .788), reoperations ( P = .999), revisions ( P = .118), or Patient-Reported Outcomes Measurement Information System (PROMIS) scores between the 2 groups. Multivariable analyses performed demonstrated no evidence of association between undergoing same-day discharge TAA vs inpatient TAA and reoperation, revision, complication, or 1-year PROMIS scores ( P > .05). Conclusion: In our system of health care, with appropriate patient selection, same-day discharge following TAA can be a safe alternative to inpatient TAA. Level of Evidence: Level III, retrospective cohort study.

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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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The Safety Profile of Same-Day Outpatient Total Ankle Arthroplasty

Cited by 5 publications

References 16 publications

Outpatient Total Ankle Arthroplasty (TAA) as a Rising Alternative to Inpatient TAA: A Database Analysis

Outpatient Total Ankle Arthroplasty (TAA) as a Rising Alternative to Inpatient TAA: A Database Analysis

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

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

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