ABSTRACT
The popularity and utilization of total ankle arthroplasty (TAA) as treatment for
ankle arthritis has increased exponentially from 1998 to 2012. Overall the outcomes
have improved for TAA with the introduction of new-generation implants and this has
increased the focus on optimizing other variables affecting outcomes for TAA. The
purpose of this study was to examine the effects of hospital characteristics and teaching
status on outcomes for TAA. The Nationwide Inpatient Sample database was queried from
2002 to 2012 using the ICD-9 procedure code for TAA. The primary outcomes evaluated
included: in-hospital mortality, length of stay, total hospital charges, discharge
disposition, perioperative complications, and patient demographics. Analyses were
carried out based on hospital size: small, medium, and large; and teaching status:
rural nonteaching, urban nonteaching, and urban teaching. A total weighted national
estimate of 16,621 discharges for patients undergoing TAA was reported over the 10-year
period. There were significant differences in length of stay and total charges between
all hospitals when comparing location and teaching status; however, no significant
differences were noted for in-hospital mortality. Rural, nonteaching hospitals had
higher odds of perioperative complications. There were also significant differences
in length of stay and total charges when comparing hospital sizes. Overall, there
is no increased risk of mortality after TAA regardless of hospital size or setting.
However, rural hospitals had increased rates of perioperative complications compared
to urban hospitals. Our analyses demonstrated important factors affecting cost and
resource utilization for TAA, clearly additional work is needed to optimize this relationship,
especially in the upcoming bundled payment models.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: November 26, 2022
Publication stage
In Press Corrected ProofFootnotes
Financial Disclosure: This project has not received any outside funding or grants.
Conflict of Interest: Dr. Sabesan reports grants from Exactech, Inc, personal fees from Arthrex, Inc, grants from Pacira Pharmaceuticals, grants from Orthopaedic Research and Education Foundation, outside the submitted work. All other authors, their immediate family and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
Disclaimers: This manuscript has not been previously submitted for publication. All authors have read and approved of the final manuscript. All authors believe this manuscript represents honest work.
This study was exempt from Institutional Review Board (IRB) approval.
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