Elective Foot & Ankle Procedures in the Geriatric Populations: Worth the Mobility Gains

Abstract

Category:Ankle; Hindfoot; Midfoot/ForefootIntroduction/Purpose:Chronic, non-traumatic pathologies of the foot and ankle can be mobility-limiting for patients of all ages. Given increased rates of perioperative comorbidities and the heightened risks of intraoperative complications, physicians may be more inclined to manage elderly patients with longer periods of conservative treatment for similar pathologies. However, previous work has shown that decreased mobility of elderly patients affects longevity and is linked to increased rates of all-cause and non- cancerous morbidity and mortality. Currently, little is known about the effect of elective foot and ankle procedures on mobility in patients of all ages. Therefore, the objective of this study was to compare posteroperative changes in LifeSpace Mobility Assessment (LSA) scores of adult and elderly patients following foot and ankle surgery.Methods:A prospective study of 184 patients undergoing elective ankle, hindfoot, and midfoot procedures conducted by a single surgeon between September 1, 2015 and August 31, 2019 was undertaken following IRB approval. Patient-reported LSA scores were collected at preoperative and routine 6-month and 12-month follow-up clinic appointments. Patient demographic and surgical data were recorded, and they were divided into groups by age over and under 65 years. Demographics and surgical characteristics were compared utilizing an independent sample t-test for continuous, normally distributed data and a chi-squared or Fischer's exact test for categorical data. Alpha and beta were assumed to be 0.05 and 0.8, respectively.Results:The younger (<65) group included 140 patients (mean age 44.1, SD 13.2), while 44 patients were observed in the elderly (>=65) age group (mean age 70.4 years, SD 8.4 (p<0.0001). The elderly group had significantly more patients with hypertension requiring medical management (p=0.012), but no other differences in perioperative comorbidities or demographics were observed. A higher proportion of elderly patients underwent surgery for conditions of osteoarthric origin, while younger patients underwent surgery more frequently for soft tissue pathology (p=0.033). The average LSA score of elderly patients at the preoperative visit was 58.3 (SD 38.0) versus 79.3 (SD 38.8) in the younger cohort (p=0.041). Both the young and elderly patient cohorts regained and surpassed their preoperative mobility scores by 6 months and 1-year postop. No difference in average mobility score was observed between young (85.6, SD 36.1) and elderly (90.1, SD 34.3) cohorts at 1-year follow-up.Conclusion:This study demonstrates that while elderly patients may begin with lower mobility than younger patients with foot and ankle pathology, operative treatment can improve their mobility dramatically up to comparable levels of operatively-treated younger patients. Our results, in tandem with literature showing the drastic deleterious effects of decreased mobility in the elderly, suggest that the discussion to pursue or hold on surgical correction of chronic foot and ankle disease in the patients over the age of 65 must take into account the mobility benefits of surgery.