This study sought to identify patient and operative demographics associated with 30-day perioperative complications in patients undergoing total ankle arthroplasty as recorded in the National Surgical Quality Improvement Project database. Complications were divided into local and systemic and further subcategorized as major and minor. A total of 404 patients underwent total ankle arthroplasty between 2007 and 2014 as captured in the National Surgical Quality Improvement Project database. The overall complication rate was 2.4% with 0.5% mortality and 0.2% infection rate. Length of hospital stay, both as an end point at >5 days and as a continuous variable, was associated with overall complications (odds ratio [OR] = 9.90, P = .002 and OR = 1.52, P = .006, respectively). Patient characteristics that predicted perioperative morbidity included presence of 3 or comorbidities (OR = 8.48, P = 0.038), American Society of Anesthesiologists class III, and history of previous cardiac surgery (OR = 12.22, P = .033). Correct patient selection is imperative in achieving improved outcomes and those that are at risk for complications should be counseled as such.
Levels of Evidence: Level III: Database case control study
CoesterLMSaltzmanCLLeupoldJPontarelliW.Long-term results following ankle arthrodesis for post-traumatic arthritis. J Bone Joint Surg Am. 2001;83:219-228.
2.
GouldJSAlvineFGMannRASandersRWWallingAK.Total ankle replacement: a surgical discussion: Part II. The clinical and surgical experience. Am J Orthop (Belle Mead NJ). 2000;29:675-682.
3.
EasleyMEAdamsSBJrHembreeWCDeOrioJK.Results of total ankle arthroplasty. J Bone Joint Surg Am. 2011;93:1455-1468.
4.
HaddadSLCoetzeeJCEstokRFahrbachKBanelDNalysnykL.Intermediate and long-term outcomes of total ankle arthroplasty and ankle arthrodesis. A systematic review of the literature. J Bone Joint Surg Am. 2007;89:1899-1905. doi:10.2106/JBJS.F.01149.
5.
SaltzmanCLMannRAAhrensJEet alProspective controlled trial of STAR total ankle replacement versus ankle fusion: initial results. Foot Ankle Int. 2009;30:579-596.
6.
ZaidiRCroSGurusamyKet alThe outcome of total ankle replacement: a systematic review and meta-analysis. Bone Joint J. 2013;95:1500-1507.
7.
ZhouHYakavonisMShawJJPatelALiX.In-patient trends and complications after total ankle arthroplasty in the United States. Orthopedics. 2016;39:e74-e79.
8.
KarantanaAHobsonSDharS.The Scandinavian total ankle replacement: survivorship at 5 and 8 years comparable to other series. Clin Orthop Relat Res. 2010;468:951-957.
9.
WoodPLKarskiMTWatmoughP.Total ankle replacement: the results of 100 mobility total ankle replacements. J Bone Joint Surg Br. 2010;92:958-962.
10.
BelmontPJJrGoodmanGPWatermanBRBaderJOSchoenfeldAJ.Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am. 2014;96:20-26.
11.
SchoenfeldAJOchoaLMBaderJOBelmontPJJr.Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the National Surgical Quality Improvement Program. J Bone Joint Surg Am. 2011;93:1577-1582.
12.
BelmontPJJrGoodmanGPHamiltonWWatermanBRBaderJOSchoenfeldAJ.Morbidity and mortality in the thirty-day period following total hip arthroplasty: risk factors and incidence. J Arthoplasty. 2014;29:2025-2030.
13.
BelmontPJJrGoodmanGPRodriguezMBaderJOWatermanBRSchoenfeldAJ.Predictors of hospital readmission following revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc. 2016;24:3329-3338.
14.
BelmontPJJrDaveySRensingNBaderJOWatermanBROrrJD.Patient-based and surgical risk factors for 30-day postoperative complications and mortality after ankle fracture fixation. J Orthop Trauma. 2015;29:e476-e482. doi:10.1097/BOT.0000000000000328.
15.
SchoenfeldAJSerranoJAWatermanBRBaderJOBelmontPJJr. The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43.343 cases. Acta Orthop Trauma Surg. 2013;133:1483-1491.
16.
American College of Surgeons National Surgical Quality Improvement Program. User guide for the 2011 Participant Use Data File. http://site.acsnsqip.org/wp-content/uploads/2012. Accessed June 10, 2016.
17.
ProcterLDDavenportDLBernardACZwischenbergerJB.General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg. 2010;210:60-65.e1-2.
18.
DimickJBStaigerDOHallBLKoCYBirkmeyerJD.Composite measures for profiling hospitals on surgical morbidity. Ann Surg. 2013;257:67-72.
19.
ShiloachMFrencherSKSteegerJEet alToward robust information; data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210:6-16.
20.
KrauseFGWindolfMBoraBPennerMJWingKJYoungerAS.Impact of complications in total ankle replacement and ankle arthrodesis analyzed with a validated outcome measure. J Bone Joint Surg Am. 2011;93:830-839.
21.
GlazebrookMAArsenaultKDunbarRMet alEvidence-based classification of complications in total ankle arthroplasty. Foot Ankle Int. 2009;30:945-949.
22.
ChoEHGarciaRPienIThomasSLevinLSHollenbeckST.An algorithmic approach for managing orthopaedic surgical wounds of the foot and ankle. Clin Orthop Relat Res. 2014;472:1921-1929.
23.
SchipperONHsuARHaddadSL.Reduction in wound complications after total ankle arthroplasty using a compression wrap protocol. Foot Ankle Int. 2015;36:1448-1454.
24.
GrossCEGarciaRAdamsSBDeOrioJKEasleyMENunleyJA2nd. Soft tissue reconstruction after total ankle arthroplasty. Foot Ankle Int. 2016;37:522-527.
25.
RaikinSMKaneJCiminielloME.Risk Factors for incision-healing complications following total ankle arthroplasty. J Bone Joint Surg Am. 2010;92:2150-2155.
26.
MarchantMHJrViensNACookCVailTPBolognesiMP.The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009;91:1621-1629.
27.
GrossCEGreenCLDeOrioJKEasleyMAdamsSNunleyJA2nd. Impact of diabetes on outcome of total ankle replacement. Foot Ankle Int. 2015;36:1144-1149.
28.
GrossCELampleyAGreenCLet alThe effect of obesity on functional outcomes and complications in total ankle arthroplasty. Foot Ankle Int. 2016;37:137-141.
