Impact of Surgeon Type on Total Ankle Arthroplasty Readmission, Complication, and Infection Rates

Abstract

Introduction/Purpose: Total ankle arthroplasty (TAA) remains an attractive surgical option to address end-stage ankle pathology in appropriately selected patients. When successful, TAA can yield high patient satisfaction and marked improvements in patient- reported outcomes. However, surgical complications can lead to significant clinical impairment. TAA can be performed by both orthopedic surgeons and non-orthopedic surgeons – however, no prior study has compared TAA outcomes based on surgeon type. Methods: Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent TAA based on CPT coding. Patients on Medicare HMO, under age 65, and dual-eligible patients were excluded. Within this dataset, provider type was identified, allowing for comparisons between orthopedic and nonorthopedic surgeons. We compared groups based on readmission, all-complication, and infection rates within 1-year of TAA using logistic regressions controlling for age, sex, race, and comorbidity. To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher rate of complications among patients treated by nonorthopedic surgeons. Results: During our timeframe, 8,244 Medicare patients underwent TAA – 6,928 performed by orthopedic surgeons and 1,316 performed by non-orthopedic surgeons. There were no differences between groups based on age, sex, or race. Readmission rates were similar between groups (p=0.058). TAA performed by non-orthopedic surgeons had higher all-complication rates (43.4% vs. 36.7%, p< 0.001) and infection rates (8.9% vs. 4.7%, p< 0.001) compared to nonorthopedic surgeons. These differences in all- complication risk in non-orthopedic surgeons were further seen in logistic regression analyses (5.8 ppt (95% CI: 2.3, 9.4), p< 0.001) and propensity matched analyses (5.6 ppt (95% CI: 2.1, 9.2), p< 0.001). Group-differences were also revealed in infection risk through logistic regression analyses (3.9 ppt (95% CI: 2.0, 5.9), p< 0.001) and propensity matched analyses (3.8 ppt (95% CI: 1.8, 5.8), p< 0.001). Conclusion: TAA performed by non-orthopedic surgeons had greater all-complication and infection rates as compared to TAA done by orthopedic surgeons. Analyses of complications between orthopedic surgeons and non-orthopedic surgeons performing total ankle arthroplasty