Emergency Department Visits Within 90 Days of Total Ankle Replacement - Yale School of Medicine

Journal: American Orthopaedic Foot & Ankle Society

Who: Philip P. Ratnasamy, BS, Alexander J. Kammien, BS, Michael J. Gouzoulis, BS, Irvin Oh, MD, and Jonathan N. Grauer, MD

Overview: Total ankle replacement (TAR) utilization successful the United States has steeply accrued successful caller decades. Emergency section (ED) visits pursuing TAR impacts diligent restitution and wellness attraction costs and warrant exploration.

This retrospective cohort survey utilized the 2010 to 2019 M91Ortho PearlDiver information acceptable to place TAR patients with astatine slightest 90 days of follow-up. PearlDiver contains billing claims information crossed each sites of attraction passim the United States for each indications for care. Patient factors extracted included age, sex, Elixhauser Comorbidity Index (ECI), portion of the state successful which country was performed, security plan, and postoperative infirmary magnitude of stay. Ninety- time postoperative ED sojourn incidence, timing, frequency, and superior diagnoses were identified and compared to 1-year postoperative ED sojourn baseline data. Univariate and multivariate logistic regression analyses were utilized to find hazard factors for ED visits.

Of 5930 TAR patients identified, ED visits wrong 90 days were noted for 497 (8.4%) patients. Of each ED visits, 32.0% occurred wrong 2 weeks pursuing surgery. Multivariate investigation revealed respective predictors of ED utilization: younger property (odds ratio [OR] 1.35 per decennary decrease), pistillate enactment (OR 1.20), higher ECI (OR 1.32 per 2-point increase), TAR performed successful the occidental US (OR 1.34), and Medicaid sum (OR 2.70; 1.71-4.22 comparative to Medicare) (P < .05 each). Surgical tract issues comprised 78.0% of ED visits, with surgical tract symptom (57.0%) arsenic the astir communal problem.

Of 5930 TAR patients, 8.4% returned to the ED wrong 90 days of surgery, with predisposing demographic factors identified. The highest incidence of ED visits was successful the archetypal 2 postoperative weeks, and surgical tract symptom was the astir communal reason. Pain absorption pathways pursuing TAR should beryllium capable to beryllium adjusted to minimize the occurrence of postoperative ED visits, thereby improving diligent experiences and decreasing wellness attraction utilization/costs.