Wong Liam H, Chrea Bopha, Meeker James E, Yoo Jung U, Atwater Lara C
School of Medicine, Oregon Health & Science University, Portland, OR, USA.
Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA.
Foot Ankle Orthop. 2022 May 29;7(2):24730114221101617. doi: 10.1177/24730114221101617. eCollection 2022 Apr.
Complications such as nonunion and infection following ankle arthrodesis can lead to increased patient morbidity and financial burden from repeat operations. Improved knowledge of risk factors can improve patient selection and inform post-ankle arthrodesis surveillance protocols.
This is a large retrospective, database study with structured query of a national insurance claims database (PearlDiver Technologies) for patients treated with ankle arthrodesis from 2015 to 2019 as identified by (), codes. Patients with any operation 1 year prior to or following ankle arthrodesis were excluded from analysis to prevent attributing complications to another operation. Likelihoods of nonunion and infection within 1 year and 3 years following ankle arthrodesis were analyzed using Kaplan-Meier estimations. Patient characteristics associated with the identified complications following ankle arthrodesis were analyzed using multivariable logistic regression analyses.
Our query yielded 2463 patients in the 5-year period who underwent ankle arthrodesis. Nonunion occurred in 11% (95% CI 10-12) of patients within 1 year of ankle arthrodesis and 16% (95% CI 14-17) of patients within 3 years. Infection occurred in 3.9% (95% CI 3.1-4.7) of patients within 1 year of ankle arthrodesis and in 6.2% (95% CI 5.1-7.2) of patients within 3 years. Obese patients increased odds of nonunion on multivariable analysis (OR 1.6, 95% CI 1.3-2.0; < .001). On multivariable analysis, diabetes (OR 1.7, 95% CI 1.2-2.6; = .010) and each 1-unit increase in Elixhauser Comorbidity Index scores (OR 1.1, 95% CI 1.1-1.2; < .001) contributed to increased odds of infection after ankle arthrodesis.
Nonunion and infection following ankle arthrodesis have a 3-year probability of 16% and 6%, respectively. More than one-quarter of patients with nonunion following ankle arthrodesis experience a delay in diagnosis beyond 1 year. The risk of post-ankle arthrodesis nonunion is highest in patients with obesity; the risk of post-ankle arthrodesis infection is highest in patients with diabetes or an elevated Elixhauser Comorbidity Index score.
Level III, prognostic study.
踝关节融合术后出现骨不连和感染等并发症会导致患者发病率增加以及再次手术带来的经济负担。对风险因素有更深入的了解有助于改善患者选择，并为踝关节融合术后的监测方案提供依据。
这是一项大型回顾性数据库研究，通过结构化查询国家保险理赔数据库（PearlDiver Technologies），筛选出2015年至2019年接受踝关节融合术治疗的患者（由[具体代码]识别）。排除踝关节融合术前或术后1年内进行过任何手术的患者，以避免将并发症归因于另一次手术。使用Kaplan-Meier估计法分析踝关节融合术后1年和3年内骨不连和感染的发生率。采用多变量逻辑回归分析方法分析与踝关节融合术后已识别并发症相关的患者特征。
我们的查询在5年期间共得到2463例接受踝关节融合术的患者。踝关节融合术后1年内，11%（95%CI 10-12）的患者发生骨不连，3年内为16%（95%CI 14-17）。踝关节融合术后1年内，3.9%（95%CI 3.1-4.7）的患者发生感染，3年内为6.2%（95%CI 5.1-7.2）。多变量分析显示，肥胖患者骨不连的几率增加（OR 1.6，95%CI 1.3-2.0；P<0.001）。多变量分析表明，糖尿病（OR 1.7，95%CI 1.2-2.6；P = 0.010）以及埃利克斯豪泽合并症指数评分每增加1个单位（OR 1.1，95%CI 1.1-1.2；P<0.001），都会导致踝关节融合术后感染几率增加。
踝关节融合术后骨不连和感染的3年发生率分别为16%和6%。踝关节融合术后发生骨不连的患者中，超过四分之一经历了超过1年的诊断延迟。踝关节融合术后骨不连风险在肥胖患者中最高；踝关节融合术后感染风险在糖尿病患者或埃利克斯豪泽合并症指数评分升高的患者中最高。
III级，预后研究。
