Short-Term Complications of Total Ankle Arthroplasty with and without Concomitant Bony and Soft Tissue Procedures: A Propensity Score Matched Analysis

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Category: Ankle Arthritis; Ankle Introduction/Purpose: This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), either alone or with concomitant soft tissue or bony procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes in these groups. Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent TAA (27702) between 2010 to 2021. Patients were then divided into cohorts consisting of patients who underwent TAA without concomitant procedures and patients who underwent TAA with one or more concomitant bony or soft tissue procedures. Procedures included in the development of cohorts are outlined in Table 1. Propensity score matching was then employed to account for any baseline demographic differences, and statistical analyses were performed to compare short-term complication rates between the matched cohorts. Results: A total of 2,225 patients undergoing TAA were identified, with 1,432 (64.4%) receiving TAA alone and 793 (35.6%) receiving TAA with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (172.8 vs. 144.1mins) and total length of hospital stay (LOS) (1.76 vs. 1.52 days). Rates for extended length of stay were significantly higher in the ancillary cohort compared to the simple cohort (21.2% vs 16.3%). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). When controlling for all other variables, ASA classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, p = 0.04). Conclusion: Extended length of stay was the only variable found to be significantly different between simple and concomitant TAA cohorts. Additionally, in a subgroup analysis excluding tendon lengthening procedures, we observed greater morbidity probability in the additional procedures group. The only independent risk factor for postoperative complications was ASA class 4 status. Without significant difference in rates of any AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of simple TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring TAA while having multiple foot and ankle pathologies.