Abstract
Category:
Ankle; Ankle Arthritis
Introduction/Purpose:
The incidence of total ankle arthroplasty (TAA) continues to increase as outcomes and surgeon comfort with the procedure improve. There is a paucity of literature investigating the association between operative time (case duration) and postoperative outcomes following TAA. Thus, this study seeks to evaluate the relationship between total operative time and postoperative outcomes following TAA. We hypothesize that increased operative time is statistically significantly associated with an increased risk of 30-day postoperative complications in patients undergoing total ankle arthroplasty.
Methods:
The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2020 to identify 2,133 patients undergoing TAA. Demographics, medical comorbidities, concomitant procedures, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. Patients were excluded based on an operative time greater than 290 minutes (based on Inter-Quartile Range [IQR] proximity rule) to limit the influence of extreme outliers. The cohort was predominantly male (53.8%) and mean patient age was 64.10 (range 19-87) years with a mean BMI of 31.00 (range 17.14-57.78) m/kg2. The mean operative time of the cohort was 149.56 (standard deviation [SD]=49.60) minutes.
Results:
Demographic characteristics associated with increased operative time were younger age (p <.001), functionally dependent status (p=.041), general anesthesia instead of spinal (p <.001), not having diabetes (p <.001), and not having COPD (p=.005). Multivariate analysis, accounting for these variables, revealed that a 15-minute increase in operative time led to an increase in risk of any complication by 10% (p=.019), wound dehiscence by 30% (p=.005), urinary tract infection by 38% (p=0.009), readmission by 16% (p=0.003), reoperation by 16% (p=0.048), and extended length of stay by 6% (p=0.023). Increased operative (>1 SD above the mean), independently predicted readmission (OR=2.817; 95%CI=1.334-5.951; p=0.007), urinary tract infection (OR=6.410; 95%CI=1.384-29.6866; p=0.018), wound dehiscence (OR=5.127; 95%CI=1.282-20.508; p=0.021), and bleeding requiring transfusion (OR=18.364; 95%CI=1.846-182.682; p=0.013).
Conclusion:
The study found longer operative time during TAA is associated with a statistically significant increase in complications, including wound dehiscence, urinary tract infection, readmission, reoperation, and increased length of stay. Therefore, surgeons should prioritize measures to reduce operative time when appropriate while optimizing implant placement, deformity correction, and implant stability in TAA.