Patient Perceptions of Inpatient vs Outpatient Total Ankle Arthroplasty

Research Type: Level 3 - Retrospective cohort study, Case-control study, Meta-analysis of Level 3 studies Introduction/Purpose: With advancements in third- and fourth-generation ankle implants, total ankle arthroplasty (TAA) has become increasingly prevalent. To address the rising economic burden, outpatient TAA (OTAA) has gained popularity. While patient perceptions of same-day versus overnight discharge have been studied for hip and knee arthroplasty, perceptions following OTAA versus inpatient TAA (ITAA) remain unknown. This study surveys patients to explore factors influencing their preference for OTAA or ITAA. Methods: Patients with a minimum 3-month follow-up (mean=23.56 months; range=4.31–52.47) after undergoing TAA by one of two fellowship-trained foot and ankle surgeons were surveyed regarding their surgical experience. Surveys were administered via REDCap and included questions adapted from studies on total joint arthroplasty and the CAHPS Surgical Care survey. Patients were asked about demographics, pain management, sleep, appetite, comfort, safety, financial burden, and discharge preference. Demographic data included age, sex, race, marital status, education, income, healthcare-related careers, and surgical history. Fifty-two patients completed the survey, with a mean age of 65.15 years (range 38–84), 53.8% male, and 94.2% white. Results: Most patients underwent ITAA (N=31; 59.6%), and 94.2% indicated they would choose the same discharge experience. No significant demographic differences were found between OTAA and ITAA. Sleep quality was the only notable difference, with ITAA patients reporting better sleep. Patients who would not choose the same discharge experience reported feeling less comfortable, less safe, discharged too early, and overall, less satisfied. Conclusion: Understanding patient perceptions of OTAA versus ITAA provides insight into discharge preferences. While no demographic differences influenced preference, ITAA patients prioritized pain management, while OTAA patients favored comfort. These findings may enhance patient-physician collaboration and improve care models.