scholarly journals A Comparative Analysis of Short Term Postoperative Complications in Outpatient vs. Inpatient Total Ankle Arthroplasty

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0042 ◽  
Author(s):  
Ashish Shah ◽  
Henry DeBell ◽  
Chandler Tedder ◽  
Zachariah Pinter ◽  
Sameer Naranje ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Renal Failure ◽  
Hospital Stay ◽  
Operating Room ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Inpatient Setting ◽  
Complication Rates ◽  
Ankle Arthroplasty ◽  
Significant Difference

Category: Ankle Introduction/Purpose: Ankle arthritis is a potentially debilitating disease with approximately 50,000 cases diagnosed annually. Once conservative management fails, surgical options for these patients include total ankle arthroplasty (TAA) and ankle arthrodesis. Younger, more active patients may prefer TAA as it may allow better ankle mobility compared to ankle arthrodesis. TAA has historically been performed in the inpatient setting with a one- to two-night postoperative hospital stay. Outpatient surgeries are gaining popularity due to their cost effectiveness, decreased length of hospital stay, and convenience. Therefore, it is important to evaluate the safety of specific procedures in the outpatient setting compared to the inpatient setting. This study evaluates the complication rates in inpatient vs. outpatient TAA. Methods: Our team conducted a retrospective analysis of data from 591 patients receiving inpatient and outpatient TAA from the NSQIP database. This database contains de-identified patient data and allows retrospective analyses to be performed based on data they have extracted from over 400 hospitals. Demographic information was recorded including age, sex, weight, height, and race. Thirty-day postoperative complication rates were compared between 66 outpatients and 535 inpatients. Frequencies of the following complications were analyzed: wound complications, pneumonia, hematologic complications (pulmonary embolism and deep vein thrombosis), renal failure, stroke, and return to the operating room within 30 days. The inpatient and outpatient groups were compared using chi-squared tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Results: 591 total patients were identified that underwent TAA. 66 patients (11.1%) were treated as outpatients and 525 (88.8%) as inpatients. Inpatient TAA had a significantly higher mean operation time (161 min vs 148 min) and a significant difference in length of total hospital stay (2.3 days vs 1.1 days). Inpatients had higher rates of superficial incisional surgical site infection (SSI) (0.57% vs 0%), deep SSI (0.19 % vs 0%), organ/space SSI (0.19% vs 0%), pneumonia (0.38% vs 0%), and return to the operating room (0.76% to 0%). However, no significant differences were found in complication rates between inpatient and outpatient groups. There were no occurrences of acute renal failure, wound disruption, pulmonary embolism, stroke, or DVT/thrombophlebitis for inpatients or outpatients. Conclusion: We found no significant difference between inpatient vs. outpatient TAA. Incidental differences we found were that inpatients were significantly more likely to be older in age, diagnosed with diabetes, and inpatients had longer operative times. Our results suggest that inpatients are more likely, but not significantly, to have a higher occurrence of complications and return to the OR. Therefore, this study suggests that outpatient TAA is safe and may be a superior option for the correct patient population. Further investigation is warranted to verify these conclusions.

scholarly journals Effect of Travel Time and Distance on Outcomes in Total Ankle Arthroplasty

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0015
Author(s):  
Kristin C. Caolo ◽  
Scott J. Ellis ◽  
Jonathan T. Deland ◽  
Constantine A. Demetracopoulos
Keyword(s):  
Travel Time ◽  
Complication Rate ◽  
High Volume ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Linear Regression Models ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
Drive Time

Category: Ankle; Ankle Arthritis Introduction/Purpose: Surgeons who perform a higher volume of total ankle arthroplasty (TAA) are known to have decreased complication rates; evidence shows that low volume centers performing TAA have decreased survivorship when compared with high volume centers. Understanding differences in outcomes for patients traveling different distances for their TAA is important for future patients deciding where to travel for their surgery. No study has previously examined differences in outcomes of patients traveling different distances to a high volume center for their TAA. This study compares preoperative and postoperative PROMIS scores for patients undergoing total ankle arthroplasty who traveled less than and more than 50 miles for their TAA. We hypothesized that there would be no difference in outcome scores based on distance traveled or estimated drive time. Methods: This study is a single center retrospective review of 162 patients undergoing primary total ankle arthroplasty between January 2016 and December 2018. We collected the primary address as listed in the patient’s medical record and used the directions feature on Google Maps to estimate driving mileage and estimated driving time from the patient’s address to the hospital. To analyze the distance patients traveled, patients were divided into two groups: <50 miles traveled (n=91) and >50 miles traveled (n=71). To analyze the estimated drive time, patients were divided into two groups: <90 minutes (n=77), >90 minutes (n=85). We collected preoperative and most recent postoperative PROMIS scores for all patients. Differences in most recent post-operative PROMIS scores between distance groups and travel time groups were assessed using multivariable linear regression models, adjusting for the pre-operative score and follow-up time. Results: We found no significant difference in post-operative PROMIS scores between the two groups when analyzed for distance traveled or for estimated travel time after adjustment for pre-operative PROMIS score and follow-up time (Table 1). The average follow-up for all 162 patients was 1.49 years. Power analysis showed that with a sample size of 110 (55 in each group), we had 81% power to detect an effect size of 4. Patients saw an increase in their Physical Function scores and a decrease in their Pain Interference and Pain Intensity scores with postoperative scores better than population means (Table 1). Overall complication rate for the <50 miles group was 17.6%, 7.7% required surgery. The >50 miles group had an overall complication rate of 24.0%, 9.9% required surgery. Conclusion: Patients traveling further distances to a high volume orthopedic specialty hospital for their total ankle arthroplasty do not have different clinical outcomes than patients traveling shorter distances. This is particularly important for patients deciding where to have their total ankle arthroplasty surgery. Patients who travel further have the opportunity to be treated at a local academic center; however our results show that outcomes do not change when traveling further for total ankle arthroplasty. [Table: see text]

scholarly journals Modern total ankle arthroplasty versus ankle arthrodesis: A systematic review and meta-analysis

2020 ◽  
Vol 12 (3) ◽  
Author(s):  
Cort D. Lawton ◽  
Adam Prescott ◽  
Bennet A. Butler ◽  
Jakob F. Awender ◽  
Ryan S. Selley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Treatment Options ◽  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
P Value ◽  
Eligibility Criteria ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
End Stage

The controversy in surgical management of end-stage tibiotalar arthritis with Total Ankle Arthroplasty (TAA) versus Ankle Arthrodesis (AA) has grown in parallel with the evolution of both procedures. No randomized controlled trials exist due to the vast differences in surgical goals, patient expectations, and complication profiles between the two procedures. This makes high quality systematic reviews necessary to compare outcomes between these two treatment options. The aim of this study was to provide a systematic review with meta-analysis of publications reporting outcomes, complications, and revision data following third-generation TAA and/or modern AA published in the past decade. Thirtyfive articles met eligibility criteria, which included 4312 TAA and 1091 AA procedures. This review reports data from a mean follow-up of 4.9 years in the TAA cohort and 4.0 years in the AA cohort. There was no significant difference in overall complication rate following TAA compared to AA (23.6% and 25.7% respectively, P-value 0.31). Similarly, there was no significant difference in revision rate following TAA compared to AA (7.2% and 6.3% respectively, P-value 0.65). Successful treatment of end-stage tibiotalar arthritis requires an understanding of a patients’ goals and expectations, coupled with appropriate patient selection for the chosen procedure. The decision to proceed with TAA or AA should be made on a case-by-case basis following an informed discussion with the patient regarding the different goals and complication profiles for each procedure.

scholarly journals Total Ankle Arthroplasty vs Ankle Arthrodesis

2018 ◽  
Vol 3 (2) ◽  
pp. 2473011418S0001
Author(s):  
Thomas Clanton ◽  
Lauren Matheny ◽  
Angela Chang
Keyword(s):  
Ankle Arthrodesis ◽  
Total Ankle Arthroplasty ◽  
Proportional Hazard ◽  
Foot And Ankle ◽  
Ankle Arthritis ◽  
Ankle Arthroplasty ◽  
Cox Proportional Hazard ◽  
Age At Surgery ◽  
Significant Difference ◽  
Surgical Failure

Category: Ankle, Ankle Arthritis Introduction/Purpose: Ankle arthritis is a debilitating disorder which significantly limits activities of daily living and can lead to reduced quality of life. Total ankle arthroplasty(TAA) and ankle arthrodesis are common treatments for ankle arthritis; however, patient indications may differ based on individual patient needs. Few studies compare proportional hazard modeling, survivorship and patient-centered outcomes following these two procedures, which may be useful in determining the appropriate procedure for end-stage ankle arthritis in different patient populations. The purpose of this study was to determine proportional hazards for the risk of failure in patients who underwent TAA vs. arthrodesis, as well as survivorship and outcomes. Methods: All patients >18 years, between January 2009 and November 2013, who underwent TAA or ankle arthrodesis by a single surgeon for treatment of ankle arthritis were included. Patients completed a subjective questionnaire at minimum 2-years following index surgery. Outcomes measures included Foot and Ankle Ability Measure(FAAM), Foot and Ankle Disability Index(FADI), Lysholm, WOMAC, SF-12 physical component summary(PCS) and mental component summary(MCS), Tegner activity scale and patient satisfaction with outcome. Detailed surgical data/intraoperative findings were documented at time of surgery. All data were collected prospectively. Cox proportional hazard modeling and survivorship analysis were performed to assess differences between the two cohorts. Survivorship utilizing Kaplan-Meier method, using a log-rank test, was used to compare median survivorship. Cox-proportional hazard model was conducted to compare hazard rates of surgical failure for patients in each cohort, while adjusting for age at surgery, body mass index(BMI) and sex. All outcome measures were compared between cohorts. Results: There were 97 patients available for analysis. Eight patients failed surgery(9.2%). Demographic data were documented (Table 1). There was no significant difference in failures (TAA=2 failures (6.5%) vs. arthrodesis=6 failures (11.8%)(p=0.709). There was no significant difference in survivorship of surgery between the arthrodesis cohort and the TAA cohort(p=0.785)(Table 1, Figure 1). There was a decrease in survivorship at 4 years in TAA cohort compared to arthrodesis cohort, which was not significant. The hazard ratio was 0.804 [95%CI: 0.111–5.842], indicating that cohort did not have a significant effect on the hazard of surgical failure(p=0.829). Sex, age and BMI did not have a significant effect on the hazard of surgical failure(p>0.05). There was no significant difference in any outcome measures between cohorts(Table 1). Conclusion: There was no significant difference in survivorship or in the hazard of surgical failure based on cohort (TAA and arthrodesis) while accounting for sex, age at surgery and BMI. There was no significant difference in the hazard of surgical failure for factors including age at surgery, BMI or sex. There was no significant difference in survivorship or outcomes between cohorts. Total ankle arthroplasty seems to provide similar results as arthrodesis; however, there was a decrease in survivorship at 4 years in the TAA cohort. Although not significant, this may indicate that survivorship differs during the longer-term follow-up period.

scholarly journals Comparison of second and third generation total ankle arthroplasty learning curves

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0018
Author(s):  
Ryan Callahan ◽  
Michael Aynardi ◽  
Kempland Walley ◽  
Kaitlin Saloky ◽  
Paul Juliano
Keyword(s):  
Learning Curve ◽  
Learning Curves ◽  
Total Ankle Arthroplasty ◽  
Complication Rates ◽  
Fixed Bearing ◽  
Ankle Arthroplasty ◽  
2Nd Generation ◽  
Significant Difference ◽  
Surgeon Experience ◽  
Reoperation Rates

Category: Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) has evolved over the past decades with later generation implants being associated with improved instrumentation and hardware. There have been multiple reports of the “learning curve” associated with total ankle arthroplasty. These report higher complication rates during the initial procedures performed by an inexperienced surgeon. To our knowledge, there is no comparison of the 2nd generation and 3 rd generation implant learning curves. Methods: The clinical outcomes of the first 15 cases (8/2002-4/2005) of a 2nd generation fixed bearing prosthesis (Agility Total Ankle System) and the first 15 cases (6/2007-3/2009) of a 3 rd generation fixed bearing prosthesis (Salto Talaris® TotalAnkle Prosthesis) performed by a single surgeon were retrospectively reviewed to determine complication incidence. The initial cases with each system were also independently reviewed to determine if there was a significant learning curve in regards to complications. Reoperation, infection, gutter impingement, fracture, persistent pain, and periprosthetic cyst formation were included for comparison of complication rates. Results: The overall complication rates for the Agility were 54.9% (28/51) and 35.7% (25/70) for Salto Talaris. There was no significant difference in reoperation rates when comparing the first 15 Agility cases (8/15, 53%) to the remainder of Agility cases (11/36, 30.6%) p=0.2. The initial 15 Salto Talaris cases also demonstrated no significant difference in reoperation rates (1/15, 8%) when compared to the remaining Salto Talaris replacements (7/55, 12.7%) p=1. Reoperation rates were higher in the initial 15 Agility cases (8/15, 53%) compared to the initial 15 Salto cases (1/15, 8%) p=0.01. There was no significant difference in infection, hardware failure, and medial malleolus fracture rates for any of the groups. Conclusion: While this series demonstrated no significant learning curve for each individual total ankle system, there was a significantly higher reoperation rate in the initial cases for the 2nd generation TAA when compared to the initial cases of the 3 rd generation implants. This could be attributed to improved instrumentation and hardware and/or surgeon experience.

Utility of Dehydrated Human Amniotic Membrane (DHAM) in Total Ankle Arthroplasty

2020 ◽  
Vol 41 (5) ◽  
pp. 513-520
Author(s):  
Andrew Horn ◽  
Jeremy Saller ◽  
Daniel J. Cuttica ◽  
Xue Geng ◽  
Steven Neufeld
Keyword(s):  
Postoperative Complications ◽  
Plastic Surgery ◽  
Operating Room ◽  
Amniotic Membrane ◽  
Total Ankle Arthroplasty ◽  
Wound Complications ◽  
Human Amniotic Membrane ◽  
Ankle Arthroplasty ◽  
Significant Difference ◽  
Anterior Incision

Background: Wound complications after total ankle arthroplasty (TAA) are a common postoperative complication occurring in 14% to 66% of all surgeries. Soft tissue breakdown along the anterior incision can cause exposure of anterior tendons and implant, and adhesions of the extensor tendons of the foot. Recent publications have advocated for the implantation of dehydrated human amniotic membrane (DHAM) allograft during closure of anterior ankle incisions during TAA. The goal of this study was to determine whether implantation of DHAM allograft in TAAs decreased overall postoperative wound complications. Methods: One hundred seventy patients with end-stage ankle arthritis refractory to conservative management underwent TAA with a standard anterior approach by 1 of 3 board-certified foot and ankle orthopedic surgeons. Ninety-one patients underwent closure of the anterior incision with addition of DHAM, whereas 79 patients served as the control (no addition of DHAM). The primary endpoints considered were postoperative complications and reoperation. Included in the postoperative complications was return to the operating room, postoperative plastic surgery intervention, wound communication with the implant, removal of the implant, neurolysis, tendon debridement, and extensor hallucis longus contracture/adhesions. Results: In the analysis of our demographically homogenous cohorts, there was no statistically significant difference in any postoperative complications between patients closed with DHAM and controls. Return to the operating room occurred in 8.9% of controls and 15.4% of the DHAM group ( P = .291). Similarly, there was no statistically significant difference in postoperative plastic surgery, wound communication with the implant, implant removal, neurolysis, and tendon debridement between the control and DHAM groups. Conclusion: The application of DHAM theoretically acts to decrease overall wound complications in TAA. The use of DHAM preceding wound closure in TAA did not show a statistically significant reduction in overall wound complications in our retrospective analysis. Further study, including prospective randomized studies, is needed to further investigate the effectiveness of DHAM in reducing wound complications in TAAs. Level of Evidence: Level III, retrospective cohort study.

Abstract WP341: Difference in Acute Ischemic Post Thrombolytic Stroke Outcomes in Pre Comprehensive and Post Comprehensive Status: Single Center Experience

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Vishal B Jani ◽  
Achint Patel ◽  
Jillian Schurr ◽  
Erin Shell ◽  
Julie Bey ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Secondary Outcome ◽  
Rank Test ◽  
Stroke Severity ◽  
Complication Rates ◽  
Single Center ◽  
Stroke Treatment ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Iv Tpa

Background: In last decade there is a significant change in stroke care especialy with newer data for ischemic stroke treatment there is a movement to obtain comprehensive stroke center certification (CSCC) to provide enhanced complex care for stroke. This study aims to assess the single center quality matrix assessment pre and post CSC status Methods: We reviewed single center cohort of IV tPA (tissue plasminogen activator) in-between year 2010 to 2014 at sparrow health system in mid Michigan region. This cohort was dichotomized in pre CSCC and post CSCC era. Stroke quality matrics data was collected for these patients. Severity of stroke was categorized in mild-moderate vs moderate-severe based on NIH stroke scale (NIHSS) scale. Primary out come for this study was any complication, which is composite end point of in-hospital mortality, and hemorrhage and secondary outcome was hospital stay. Chi square, student’s t test and wilcoxon sum rank test was used to compare both groups. Multivariable regression models were utilized to calculate odd ratios after adjusting with stroke severity. Results: Cohort of IV tPA was identified in-between year 2010 to 2014 (332 hospitalizations off which 241 were pre CSCC and 91 were Post CSCC ). In- hospital complication was lower after receiving CSCC (9.89% vs. 21.99%; p:0.011). In multivariable regression analysis the trend for in hospital complication persisted [Adjusted Odds ratio (OR):0.43–95%confidence-Interval(CI):0.20-0.93–p:0.032] but there was no significant difference in hospital stay (Median days 5 vs. 5; P:673) Conclusion: There is a clear and persistent trend of low in-hospital complication rates after acquiring CSCC quality matrics.

scholarly journals Effect of Social Support and Marital Status on Perceived Surgical Effectiveness and 30-Day Hospital Readmission

2017 ◽  
Vol 7 (8) ◽  
pp. 774-779 ◽  
Author(s):  
Owoicho Adogwa ◽  
Aladine A. Elsamadicy ◽  
Victoria D. Vuong ◽  
Ankit I. Mehta ◽  
Raul A. Vasquez ◽  
...  
Keyword(s):  
Social Support ◽  
Hospital Stay ◽  
Marital Status ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Complication Rates ◽  
Readmission Rates ◽  
Outcomes Measures ◽  
Significant Difference ◽  
Patient Reported

Study Design: Retrospective cohort review. Objective: To determine whether higher levels of social support are associated with improved surgical outcomes after elective spine surgery. Methods: The medical records of 430 patients (married, n = 313; divorced/separated/widowed, n = 71; single, n = 46) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized by their marital status at the time of surgery. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients had prospectively collected outcomes measures and a minimum of 1-year follow-up. Patient reported outcomes instruments (Oswestry Disability Index, Short Form–36, and visual analog scale–back pain/leg pain) were completed before surgery, then at 1 year after surgery. Results: Baseline characteristics were similar in all cohorts. There was no statistically significant difference in the length of hospital stay across all 3 cohorts, although “single patients” had longer duration of in-hospital stays that trended toward significance (single 6.24 days vs married 4.53 days vs divorced/separated/widowed 4.55 days, P = .05). Thirty-day readmission rates were similar across all cohorts (married 7.03% vs divorced/separated/widowed 7.04% vs single 6.52%, P = .99). Additionally, there were no significant differences in baseline and 1-year patient reported outcomes measures between all groups. Conclusions: Increased social support did not appear to be associated with superior short and long-term clinical outcomes after spine surgery; however, it was associated with a shorter duration of in-hospital stay with no increase in 30-day readmission rates.

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