Additional Procedures at the Time of Total Ankle Replacement Do Not Increase Risk of Short-term Complications: A Matched Cohort Analysis.
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2024-07
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Abstract
Background
This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), alone or with concomitant procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes.Methods
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using Current Procedural Terminology (CPT) codes to identify patients who underwent TAA (27702) between 2010 to 2021. Patients were divided into cohorts based on the presence or absence of ancillary procedures. Propensity score matching was employed to account for demographic differences, and statistical analyses were performed to compare short-term complication rates between matched cohorts.Results
A total of 2225 patients were identified, with 1432 (64.4%) receiving TAA alone and 793 (35.6%) with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (P < .001) and length of hospital stay (LOS) (P < 0.001). Rates for extended LOS were significantly higher in the ancillary cohort than in the simple cohort (P = .01). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). American Society of Anesthesiologists classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, P = .04). Matched subgroup analysis excluding tendon lengthening as a concomitant procedure found that the ancillary cohort still had longer operative time (P < .001) and LOS (P < .05) than patients undergoing simple TAA.Conclusion
Without significant difference in rates of AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring additional corrective procedures at the time of TAA.Level of evidence
Level III, retrospective comparative study.Type
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Peri, Maria I, Sarah Whitaker, Sarah Cole, Albert Anastasio, James R Satalich, Conor N O'Neill, Tejas T Patel, James A Nunley, et al. (2024). Additional Procedures at the Time of Total Ankle Replacement Do Not Increase Risk of Short-term Complications: A Matched Cohort Analysis. Foot & ankle orthopaedics, 9(3). p. 24730114241268150. 10.1177/24730114241268150 Retrieved from https://hdl.handle.net/10161/34704.
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Scholars@Duke
Conor Neumann O'Neill
James Albert Nunley
My current research interests are both clinical and basic science. Currently, in the Orthopaedic Research Laboratory, we are investigating the biomechanical properties of the deltoid ligament in the ankle. This is a clinically relevant problem and we will hopefully identify ways to improve the correction of the adult relaxed flat foot. We are also performing a preliminary investigation into the blood supply of the distal tibia to look for a vascularized bone transfer.
We have recently completed a biomechanical study looking at the strength of fixation for proximal metatarsal osteotomies in the correction of hallux valgus and that information has been submitted for publication.
Clinical projects have looked into nerve palsies after total elbow replacement and to reconstructive upper and lower extremity surgery.
Mark Erik Easley
Karl Martin Schweitzer
My pursuit of a career in orthopaedics has come as no surprise to those around me. Growing up on our family horse farm in Mechanicsburg, Pa., afforded me many mechanical tasks. Foot and ankle orthopaedic surgery was an obvious choice: the diverse patient population, challenging surgeries, exciting research, and the ability to help my patients get back to the activities they enjoy most.
I do not take for granted my wonderful mentors throughout residency and fellowship training. I am thankful to be practicing back where my interest in foot and ankle was first ignited. My wife Samantha and I are excited to be back living in the Triangle.
As medical missionary, Dr. Albert Schweitzer said, “At times our own light goes out and is rekindled by the spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.” It is my responsibility, but also privilege as a surgeon, to empower my patients with ‘that light’, through optimism, knowledge, and ultimately relief, through both non-operative and surgical means.
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