Odum Susan M, Van Doren Bryce A, Anderson Robert B, Davis W Hodges
1OrthoCarolina Research Institute, Charlotte, North Carolina 2Health Services Research Program, College of Health & Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina 3OrthoCarolina Foot and Ankle Institute, Charlotte, North Carolina.
J Bone Joint Surg Am. 2017 Sep 6;99(17):1469-1475. doi: 10.2106/JBJS.16.00944.
Ankle arthrodesis has been the traditional surgical treatment for end-stage hindfoot arthritis. However, utilization of total ankle arthroplasty (TAA) is increasing as surgical techniques and implants have substantially improved. The purpose of this study was to compare the U.S. national rates of perioperative (in-hospital) complications between a statistically matched cohort of patients who underwent either an ankle arthrodesis or a TAA.
Data from the 2002 to 2013 Nationwide Inpatient Sample releases were analyzed. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify 4,192 patients treated with TAA (ICD 81.56) and 16,278 treated with ankle arthrodesis (ICD 81.11). ICD-9-CM diagnosis codes were utilized to identify major and minor in-hospital complications, and mortality was determined using the Uniform Bill patient disposition. The arthrodesis and TAA groups were matched with regard to age, sex, race, surgery year, hospital type, comorbidities, adjunctive procedures, and surgical indication. Unadjusted and adjusted in-hospital complication risks were compared between groups using the Fisher exact test and multiple logistic regression analysis.
We were able to statistically match 1,574 patients who underwent a TAA (37.5%) with a patient who underwent arthrodesis. A major in-hospital complication occurred in 8.5% (134) of the 1,574 patients in the ankle arthrodesis group compared with 5.3% (84) of the 1,574 in the TAA group (p < 0.001) whereas a minor complication was found in 4.7% (74) in the ankle arthrodesis group compared with 5.9% (93) in the TAA group (p = 0.14). There were no deaths in either group. After adjusting for case mix, we found that ankle arthrodesis was 1.8 times more likely to be followed by a major complication (odds ratio [OR] = 1.78, 95% confidence interval [CI] = 1.32 to 2.39) whereas the minor complication rate was 29% lower in that group (OR = 0.71, 95% CI = 0.45 to 1.13).
In a matched cohort of 3,148 patients treated with either TAA or ankle arthrodesis, ankle arthrodesis was associated with a 1.8 times higher risk of a major complication but a 29% lower risk of a minor complication. Our findings are consistent with other studies that have shown TAA to be a safe procedure in the inpatient environment.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
踝关节融合术一直是终末期后足关节炎的传统手术治疗方法。然而，随着手术技术和植入物的显著改进，全踝关节置换术（TAA）的应用正在增加。本研究的目的是比较在统计学上匹配的接受踝关节融合术或TAA的患者队列的美国围手术期（住院期间）并发症发生率。
分析了2002年至2013年全国住院患者样本发布的数据。使用国际疾病分类第九版临床修订本（ICD-9-CM）手术编码来识别4192例接受TAA治疗的患者（ICD 81.56）和16278例接受踝关节融合术治疗的患者（ICD 81.11）。利用ICD-9-CM诊断编码来识别主要和次要的住院并发症，并使用统一账单患者处置情况确定死亡率。踝关节融合术组和TAA组在年龄、性别、种族、手术年份、医院类型、合并症、辅助手术和手术指征方面进行了匹配。使用Fisher精确检验和多元逻辑回归分析比较两组之间未调整和调整后的住院并发症风险。
我们能够在统计学上匹配1574例接受TAA的患者（37.5%）与接受踝关节融合术的患者。踝关节融合术组1574例患者中有8.5%（134例）发生了主要住院并发症，而TAA组1574例患者中有5.3%（84例）发生了主要住院并发症（p<0.001）；踝关节融合术组有4.7%（74例）发生了次要并发症，而TAA组有5.9%（93例）发生了次要并发症（p=0.14）。两组均无死亡病例。在对病例组合进行调整后，我们发现踝关节融合术后发生主要并发症的可能性是TAA的1.8倍（优势比[OR]=1.78，95%置信区间[CI]=1.32至2.39），而该组的次要并发症发生率低29%（OR=0.71，95%CI=0.45至1.13）。
在3148例接受TAA或踝关节融合术治疗的匹配队列中，踝关节融合术发生主要并发症的风险高1.8倍，但次要并发症的风险低29%。我们的研究结果与其他研究一致，这些研究表明TAA在住院环境中是一种安全的手术。
治疗性III级。有关证据水平的完整描述，请参阅作者指南。
