Foot & Ankle International - 2017 FAI Supplement - 2S

729170
research-article2017

FAIXXX10.1177/1071100717729170Foot & Ankle InternationalAOFAS Annual Meeting 2017

AOFAS Annual Meeting 2017

AOFAS Annual Meeting Abstracts 2017

Do Patient Risk Factors Impact 90Day Readmission After Total Ankle
Arthroplasty?
Samuel Adams, MD, Daniel Cunningham, BS,
Vasili Karas, MD, Mark Easley, MD, James
DeOrio, MD, James Nunley, MD
Category: Ankle, Ankle Arthritis
Keywords: Total ankle arthroplasty, 90-day readmission,
Comprehensive Care for Joint Replacement, ankle arthritis,
complications, patient comorbidities
Introduction/Purpose: The Comprehensive Care for Joint
Replacement model (CJR) provides bundled payments for inhospital and 90-day post-discharge care of patients undergoing lower extremity joint replacement including hip, knee,
and ankle arthroplasty (THA, TKA, and TAA). Pre-operative
risk factors influencing in-hospital and post-discharge costs
are, thus, of keen interest. While THA and TKA have been
reported to have a 5.3% 90-day readmission rate associated
with race, gender, increased BMI, >2 medical comorbidities,
increased length of stay, and discharge to inpatient rehab, little
is known about factors that influence readmission rates after
TAA. The purpose of this study is to identify risk factors associated with 90-day readmission after TAA.
Methods: 1,048 patients undergoing TAA (ICD-9 81.56 or
ICD-10 0SRF/G) at a single academic institution were prospectively enrolled into an ongoing, IRB-approved longitudinal TAR outcome study between 2007 and 2016. Records
were retrospectively reviewed to determine patient, operative,
and post-operative characteristics including age, gender, race,
risk factors of the Charlson-Deyo comorbidity and Elixhauser
indices, post-discharge disposition, BMI, length of stay, and
ASA score. Pre-operative Elixhauser and Charlson-Deyo
comorbidities were recorded using standardized ICD-9 and

Foot & Ankle International®
2017, Vol. 38(1S) 2-53
© The Author(s) 2017
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DOI: 10.1177/1071100717729170
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ICD-10 codes. Univariate tests of significance (t-tests for continuous inputs and chi-square tests for categorical inputs)
were performed to determine the potential relationship
between patient characteristics and 90-day readmission using
JMP Pro version 13.0.0. The tables display pre-operative
cohort-level and outcome-specific patient characteristics as
well as the results of significance testing for comorbidities
with >1% prevalence.
Results: Thirty of 1048 (2.9%) patients were readmitted
after TAA during the 90 day post-discharge window.
Twenty-two (73%) of the patients were readmitted for surgical wound complication. The majority of the remaining
8 admissions were for medical illnesses not clearly related
to the index procedure. Prevalent comorbidities included
hypertension, cardiac arrhythmias, depression, obesity,
rheumatoid arthritis, diabetes, hypothyroidism, and
chronic obstructive pulmonary disease. However, there
were no significant differences in patient characteristics
between those who were readmitted and those who were
not readmitted although patients that were readmitted
tended to be slightly older, were less likely to be discharged to SNF or in-hospital rehabilitation, and had
higher ASA score and Charlson-Deyo comorbidity index.
No individual patient comorbidities were statistically
associated with 90-day readmission.
Conclusion: The 90-day readmission rate of 2.9% after
TAA at our institution is lower than reported rates for THA
and TKA nationally (5.3%). Although our patient population had a similar prevalence of risk factors when compared
to THA/TKA patients, none of these factors were significantly associated with 90-day readmission. These data suggest that grouping TAA with THA and TKA for CJR may
not be advisable. In an emerging era of bundled payments,
further work is needed to delineate factors strongly associated with costly readmissions specific to surgical treatment
and individualized based on pre-operative patient profile.
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