Predictors of Readmission Following Total Ankle Arthroplasty

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: As total ankle arthroplasty (TAA) continues to grow in use for the treatment of end stage ankle arthritis, it is vital to identify and overcome factors which can increase patients' risk for readmission. The purpose of this study is to evaluate which factors affect patients’ risk for readmission within 180 days following primary TAA. Methods: The Nationwide Readmissions Database (NRD) was queried from 2016 to 2020 to identify 29,705 patients undergoing primary elective TAA. Patients were divided into two cohorts based on having been readmitted within 180 days of their index procedure (N=2,856; 9.4%). Bivariate and multivariate regression analyses were conducted to identify any preoperative demographics, comorbidities, hospital information, and total length of stay (LOS) that independently predict readmission. Results: The overall cohort was majority male (54.2%) with mean age of 64.15 (range 17-90) years. Patients being readmitted following TAA demonstrated statistically significantly higher rates of COPD, fluid electrolyte disorders, and active smoking status. After conducting a multivariate regression analysis, it was found that an increased risk of readmission can be statistically significantly predicted by a diagnosis of CHF (odds ratio [OR]=1.281), solid tumor (OR=2.457), fluid electrolyte disorder (OR=1.423), and active smoking at time of surgery (OR= 1.161). Conclusion: Patients who are active smokers, or have a diagnosis of CHF, solid tumor, or fluid electrolyte disorder are at a statistically significantly increased risk of readmission following primary elective TAA. Physicians should consider these findings and appropriately educate patients and allocate resources to address these increased risks.