Mercier Michael R, Ratnasamy Philip P, Yee Nicholas S, Hall Brandon, Del Baso Christopher, Athar Mohammed, Daniels Timothy R, Halai Mansur M
Division of Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA.
Foot Ankle Orthop. 2023 Dec 21;8(4):24730114231218011. doi: 10.1177/24730114231218011. eCollection 2023 Oct.
End-stage ankle osteoarthritis is a condition that can be treated with ankle arthrodesis (AA) or total ankle arthroplasty (TAA). The goal of this study is to estimate the 2016-2017 United States' utilization of TAA and AA in specific ambulatory settings and delineate patient and hospital factors associated with the selection of TAA vs AA for treatment of ankle osteoarthritis.
TAA and AA procedures performed for ankle osteoarthritis were identified in the 2016-2017 Nationwide Ambulatory Surgery Sample (NASS) Database. Notably, the NASS database only examines instances of ambulatory surgery encounters at hospital-owned facilities. As such, instances of TAA and AA performed at privately owned or freestanding ambulatory surgical centers or those performed inpatient are excluded from this analysis. Cases were weighted using nationally representative discharge weights. Univariate analyses and a combined multiple logistic regression model were used to compare demographic, hospital-related, and socioeconomic factors associated with TAA vs AA.
In total, 6577 cases were identified, which represents 9072 cases after weighting. Of these, TAA was performed for 2233 (24.6%). Based on the logistic regression model, several factors were associated with increased utilization of TAA vs AA. With regard to patient factors, older patients were more likely to undergo TAA, as well as females. Conversely, patients with a higher comorbidity burden were less likely to receive TAA over AA.With regard to socioeconomic factors, urban teaching and urban nonteaching hospitals were significantly more likely to use TAA compared to rural hospitals. Similarly, privately insured patients and those with a median household income of $71 000 or more were also more likely to receive TAA over AA. Private hospitals ("not-for-profit" and "investor-owned") were significantly more likely to offer TAA over AA.
Using a large nationally representative cohort, the current data revealed that during 2016-2017, 24.6% of operatively treated cases of end-stage ankle osteoarthritis in the ambulatory setting are treated with TAA. Associations between socioeconomic and hospital-level factors with TAA utilization suggest that nonclinical factors may influence surgical treatment choice for ankle osteoarthritis.
Level III, retrospective cohort study.
终末期踝关节骨关节炎是一种可通过踝关节融合术（AA）或全踝关节置换术（TAA）进行治疗的疾病。本研究的目的是估计2016 - 2017年美国在特定门诊环境中TAA和AA的使用情况，并确定与选择TAA或AA治疗踝关节骨关节炎相关的患者和医院因素。
在2016 - 2017年全国门诊手术样本（NASS）数据库中识别出因踝关节骨关节炎而进行的TAA和AA手术。值得注意的是，NASS数据库仅检查医院所属机构的门诊手术情况。因此，在私人拥有或独立的门诊手术中心进行的TAA和AA手术实例或住院手术实例被排除在本分析之外。病例使用具有全国代表性的出院权重进行加权。单因素分析和联合多因素逻辑回归模型用于比较与TAA和AA相关的人口统计学、医院相关和社会经济因素。
总共识别出6577例病例，加权后代表9072例病例。其中，2233例（24.6%）进行了TAA。基于逻辑回归模型，几个因素与TAA相对于AA的使用增加相关。关于患者因素，老年患者以及女性更有可能接受TAA。相反，合并症负担较高的患者接受TAA而非AA的可能性较小。关于社会经济因素，与农村医院相比，城市教学医院和城市非教学医院使用TAA的可能性显著更高。同样，私人保险患者以及家庭收入中位数为71000美元或以上的患者接受TAA而非AA的可能性也更高。私立医院（“非营利性”和“投资者所有”）提供TAA而非AA的可能性显著更高。
利用一个具有全国代表性的大型队列，当前数据显示在2016 - 2017年期间，门诊环境中终末期踝关节骨关节炎手术治疗病例的24.6%采用TAA治疗。社会经济和医院层面因素与TAA使用之间的关联表明，非临床因素可能会影响踝关节骨关节炎的手术治疗选择。
III级，回顾性队列研究。
