Document Type

Conference Proceeding

Publication Date

4-12-2024

Abstract

OBJECTIVE: Same-day discharge Total Ankle Arthroplasty (TAA) is becoming more common. This study sought to report the percentage of patients within a national database that had a same-day discharge following TAA, and to compare the complication rates for patients that had same-day discharge to those that had a short hospital stay. METHODS: From 2012-2021, the National Surgical Quality Improvement Project (NSQIP) database was used to identify all patients undergoing TAA. All patients discharged to their home on the day of surgery were identified. A comparison cohort of patients with a hospital stay of 1 to 2 days who were then discharged home was also identified, referred to as the short-stay cohort. Demographic, comorbid, and operative variables were collected. 30-day postoperative complications were then identified and compared between cohorts. RESULTS: 219 were identified in the same-day cohort and 1,509 patients were identified in the short-stay cohort. The proportion of same-day discharges in the total sample increased from 4% in 2012, 6% in 2019, to 30.5% in 2021. There was no difference in preoperative patient variables. Operative time was shorter in the same-day cohort. There was no difference in readmission, medical complications, deep surgical site infection (SSI), wound dehiscence, or rates of reoperation between cohorts and this was confirmed on multivariate analysis. However, the rate of superficial SSI was increased in the same-day cohort (2.7%) compared to the short-stay cohort (0.6%) (p=0.003). On multivariate analysis, this equated to a 5.27 (confidence interval: 1.81- 15.32, p=0.002) times increased odds of superficial SSI in the same-day cohort compared to the short-stay cohort. CONCLUSION: Same-day discharge TAA has been increasing rapidly in recent years, a rise likely augmented by a transition to outpatient surgery during the COVID-19 pandemic and TAA’s removal from the Medicare inpatient-only list in 2021. Same day-discharge TAA was associated with higher rates of superficial SSI but not deep SSI. This was true even though surgical times, and likely the complexity of surgery, was greater in the short-stay cohort. The reasons for this increased rate of superficial SSI could include a decreased use of prophylactic postoperative I.V. antibiotic administration in those with a same-day discharge.

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Mid-America Orthopaedic Association 41st Annual Meeting, April 10-14, 2024, Bonita Springs, FL

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