Short-Term Outcomes of Primary Total Ankle Arthroplasty in Octogenarians: A National Database Analysis.

BACKGROUND: Total ankle arthroplasty (TAA) is an increasingly popular option for end-stage ankle arthritis. Americans over the age of 80 years grew to 16.7 million in 2010, but there are scarce data assessing the outcomes of octogenarians undergoing TAA. This study evaluated (1) perioperative factors, (2) 30-day postoperative complications compared to a nonoctogenarian cohort, and (3) independent risk factors for adverse outcomes. METHODS: A national database registry was queried for patients who had undergone primary TAA. This yielded 1113 patients, under (n = 1059) and over (n = 54) age 80 years. Demographics and perioperative data were compared using Fisher's exact, χ2, and independent-samples t tests. Logistic and Poisson regressions were used to calculate odds ratio (OR) of complications and independent risk factors. RESULTS: The octogenarian cohort had longer in-hospital length of stay (1.9 vs 2.5 days, P < .0001). Octogenarians were not significantly more likely to develop any complication (OR = 1.32; 95% confidence interval = 0.29-6.04; P = .722), or increased number of complications (OR = 1.18; 95% CI = 0.27-5.18; P = .820). Octogenarians had significantly increased risk of being discharged to rehab/skilled nursing (OR = 6.60; 95% CI = 2.16-20.15; P < .001) instead of home. CONCLUSION: Although the elderly population may carry inherent risk factors, octogenarians do not present an increased risk of short-term complications following TAA. LEVELS OF EVIDENCE: Therapeutic, Level III: Retrospective cohort study.

The Effect of Operating Room Size on Orthopaedic Surgical Site Infection Rates.

OBJECTIVE: With many preventable causes of surgical site infections (SSIs) identified, the effect of operating room (OR) size on SSI rates has not been assessed. This study investigated the effect of OR size on incidence of SSIs for orthopaedic procedures. BACKGROUND: SSIs remain a common complication within the perioperative realm. Responsible for increasing length of hospitalization and costs, SSIs result in a decreased quality of life for patients. METHODS: A retrospective review of 11,163 patients who underwent orthopaedic surgery-including total knee and hip arthroplasties, laminectomies, and spinal fusions-between January 2018 and January 2020 were reviewed. Total net square footage (NSF) of all ORs was recorded, and incidence of SSIs was calculated. Cases were categorized based on the size of the OR (small: 250 to 399 NSF; medium: 400 to 549 NSF; and large: 550 to 699 NSF). Chi-square analysis compared infection rates between the different OR sizes, and a binary logistic regression model identified other predictors of infection. RESULTS: Overall, 137 patients (1.2%) developed an SSI. Of these infections, 16 (11.7%) occurred in small ORs, 83 (60.6%) in medium ORs, and 38 (27.7%) in large ORs. The incidence of SSIs was 0.7% in small ORs, 1.3% in medium ORs, and 1.8% in large ORs. Factors found to significantly impact SSI's included medium-sized ORs, younger patients, procedure type (fusions and emergencies/traumas), longer procedures, and higher American Society of Anesthesiologists scores (>3). CONCLUSION: Our study shows that OR size in addition to various other perioperative parameters plays a role in the rate of SSIs for orthopaedic procedures. LEVEL OF EVIDENCE: Retrospective Cohort Study; Level III Evidence.

Cost Analysis of Routine Examination of Pathology Specimens Following Ankle Arthroscopy.

BACKGROUND: Routine submission of pathologic specimens for histologic analysis following orthopedic surgery is a common and often required practice in the United States. Prior orthopedic studies have determined that these histologic examinations are of limited cost effectiveness and low clinical value because rarely do the pathology findings alter patient management. The purpose of this study was to evaluate the cost effectiveness and clinical significance of routine histologic examination of tissue specimens removed during ankle arthroscopy. METHODS: Between 2014 and 2018, 408 patients underwent ankle arthroscopy at a multi-center hospital system by 16 different orthopedic surgeons. The available pathology reports from these cases were retrospectively reviewed to determine if the routine histologic examination altered patient care. We compared the preoperative diagnosis to both the postoperative and histologic diagnoses. The total cost for these histologic examinations was estimated using 2017 Medicare physician fees released by the College of American Pathologists. Cost-effectiveness was estimated in 2017 US dollars by cost per discrepant and discordant diagnosis. RESULTS: Of the 408 patients who underwent ankle arthroscopy, 361 pathology reports were available for review. The prevalence of concordant diagnosis was 98.9% (357/361); the prevalence of discrepant diagnoses was 1.0% (4/361). There were no cases identified with a discordant diagnosis. Total estimated cost for all pathology specimens was $46 381 in 2017 US dollars. Cost per discrepant diagnosis was $11 595. CONCLUSION: In our study, histologic examination of surgical specimens following ankle arthroscopy had no effect on patient management, yet it increased costs. Routine examination of these pathologic specimens had a low rate of discrepant and/or discordant diagnoses. Based on our results, routine pathologic examination of ankle arthroscopy tissue specimens should be sent solely at the discretion of the orthopedic surgeon as opposed to being a mandated policy. LEVEL OF EVIDENCE: Level IV, case series.

Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient Demographics.

PURPOSE: To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. METHODS: We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation. RESULTS: Patients who canceled were significantly older (46.5 years vs 41.5 years, t = 2.432, P = .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, χ2 = 10.85, P = .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, χ2 = 5.35, P = .021), non-English-speaking patients (29.5% vs 11.6%, χ2 = 11.43, P = .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, χ2 = 9.96, P = .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language. CONCLUSIONS: Increased age (≥46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation. LEVEL OF EVIDENCE: Level III, case-control study.