Discharge to a Non-Home Destination Following Total Ankle Arthroplasty (TAA): An Analysis of the ACS-NSQIP Database.

Abstract

Despite an increasing trend in the number of total ankle arthroplasties (TAAs) being done globally, current evidence remains limited with regards to factors influencing a non-home discharge to a facility following the procedure. The 2012-2016 American College of Surgeons - National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27702 for patients undergoing TAA. Discharge to a destination was categorized into home and non-home. Multivariate analysis using logistic regression models were used to evaluate independent risk factors associated with non-home discharge disposition. As a secondary objective, we also evaluated risk factors associated with a prolonged length of stay (LOS) >2 days. A total of 722 TAAs were retrieved for final analysis. A total of 68 (9.4%) patients experienced a non-home discharge following the surgery. Independent factors for a non-home discharge were a LOS >2 days (odds ratio [OR] 10.51), age ≥65 years (OR 4.52), female (OR 2.90), hypertension (OR 2.63), and American Society of Anesthesiologists >II (OR 2.01). A total of 174 (24.1%) patients stayed in the hospital for more than 2 days. Significant risk factors for LOS >2 days were age ≥65 years (OR 1.62), female (OR 1.53), operative time >150 minutes (OR 1.91), and an inpatient admission status (OR 4.74). With limited literature revolving around outcomes following TAA, the current study identifies significant predictors associated with a non-home discharge. Providers should consider preoperatively risk-stratifying and expediting discharge in these patients to reduce the costs associated with a prolonged hospital length of stay.