Abstract
The objective of this study was to assess the time trends in utilization, clinical characteristics, and outcomes of patients undergoing total ankle arthroplasty (TAA) in the USA. We used the Nationwide Inpatient Sample (NIS) data from 1998 to 2010 to examine time trends in the utilization rates of TAA. We used the Cochran Armitage test for trend to assess time trends across the years and the analysis of variance (ANOVA), Wilcoxon test, or chi-squared test (as appropriate) to compare the first (1998–2000) and the last time periods (2009–2010). TAA utilization rate increased significant from 1998 to 2010: 0.13 to 0.84 per 100,000 overall, 0.14 to 0.88 per 100,000 in females, and from 0.11 to 0.81 per 100,000 in males (p < 0.0001 for each comparison for time trends). Compared to the 1998–2000 period, those undergoing TAA in 2009–2010 were older (41 % fewer patients <50 years, p < 0.0001), less likely to have rheumatoid arthritis as the underlying diagnosis (55 % fewer patients, p = 0.0001), more likely to have Deyo-Charlson index of 2 or more (197 % more, p = 0.0010), and had a shorter length of stay at 2.5 days (17 % reduction, p < 0.0001). Mortality was rare ranging from 0 to 0.6 % and discharge to inpatient facility ranged 12.6–14.1 %; we noted no significant time trends in either (p > 0.05). The utilization rate of TAA increased rapidly in the USA from 1998 to 2010, but post-arthroplasty mortality rate was stable. Underlying diagnosis and medical comorbidity changed over time and both can impact outcomes after TAA. Further studies should examine how the outcomes and complications of TAA have evolved over time.
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Acknowledgments
JAS is supported by grants from the Agency for Health Quality and Research Center for Education and Research on Therapeutics (AHRQ CERTs) U19 HS021110; the National Institute of Arthritis, Musculoskeletal and Skin Diseases (NIAMS) P50 AR060772 and U34 AR062891; the National Institute of Aging (NIA) U01 AG018947; the National Cancer Institute (NCI) U10 CA149950; and research contract CE-1304-6631 from Patient Centered Outcomes Research Institute (PCORI). JAS is also supported through the use of resources and facilities at the VA Medical Center at Birmingham, AL, USA.
Disclosures
There are no financial conflicts related directly to this study. JAS has received research and travel grants from Takeda and Savient and consultant fees from Savient, Takeda, Ardea, and Regeneron. RR has no conflicts.
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Singh, J.A., Ramachandran, R. Time trends in total ankle arthroplasty in the USA: a study of the National Inpatient Sample. Clin Rheumatol 35, 239–245 (2016). https://doi.org/10.1007/s10067-014-2703-2
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DOI: https://doi.org/10.1007/s10067-014-2703-2