Age, race, comorbidity, and insurance payer type are associated with outcomes after total ankle arthroplasty.

Abstract

To assess whether age, race/ethnicity, comorbidity, and insurance payer status are associated with outcomes after total ankle arthroplasty (TAA). Using the US National Inpatient Sample (NIS) data and multivariable-adjusted logistic regression, we assessed the association of age, race/ethnicity, comorbidity ,and insurance payer status, with healthcare utilization and in-hospital complications (infection, transfusion, and revision surgery) after TAA. We calculated odds ratio (OR) and 95% confidence intervals (CI). The cohort consisted of 6280 TAAs with a mean age of 62 years; 52% were female, 70% White, and 62% had osteoarthritis as the underlying diagnosis. Compared to age < 50 years, older age categories had higher ORs of total hospital charges above the median, length of hospital stay above the median (>2 days) and discharge to a rehabilitation facility, 1.26-19.41, and a lower OR of in-hospital infection, 0.07-0.09. Compared to Whites, Blacks had higher OR (95% CI) of: discharge to a rehabilitation facility, 1.45 (1.06, 1.98); length of hospital stay >2 days, 2.21 (1.37, 3.57); in-hospital transfusion, 4.39 (1.87, 10.30); and in-hospital revision, 8.25 (1.06, 64.21); and Hispanics were more likely to have total hospital charges above the median, OR 1.49 (1.10, 2.02), and infection, 9.30 (1.27, 68.05). Higher comorbidity and Medicare payer status were each associated with higher ORs of healthcare utilization, ORs ranging 1.20-2.57 and 1.74-2.19, respectively. Age, race/ethnicity, comorbidity, and insurance payer status were independently associated with post-TAA outcomes. Further insight into modifiable mediators of these associations can pave the way for improving these outcomes in the future.Key Points• Older age was associated with higher healthcare utilization post-ankle arthroplasty.• Compared to Whites, Blacks or Hispanics had higher healthcare utilization and in-hospital complications post-ankle arthroplasty.• Higher comorbidity and Medicare payer status were each associated with higher healthcare utilization post-ankle arthroplasty.