Journal article
Trends in the Use of Total Ankle Replacement and Ankle Arthrodesis in the United States Medicare Population
Foot & ankle international, Vol.35(3), pp.207-215
03/2014
DOI: 10.1177/1071100713511606
PMID: 24177759
Abstract
Background:
Total ankle replacement (TAR) has gained acceptance as an alternative to traditional ankle arthrodesis (AA) for end-stage ankle arthritis. Little is known about long-term trends in volume, utilization, and patient characteristics. The objective of this study was to use longitudinal data to examine temporal trends in TAR and AA.
Methods:
We identified all United States fee-for-service Medicare beneficiaries who underwent TAR and AA between 1991 and 2010 (n = 5871 and 29 532, respectively). We examined changes in patient demographics and comorbidity, nationwide and hospital volume, per capita utilization, and length of stay (LOS).
Results:
Between 1991 and 2010, both TAR and AA patients had modest shifts in characteristics, with higher rates of diabetes and obesity. Overall, TAR Medicare volume increased by more than 1000% from 72 procedures in 1991 to 888 in 2010, while per-capita standardized utilization increased 670.8% (P < .001). AA volume increased 35.8% from 1167 procedures in 1991 to 1585 in 2010, while per-capita standardized utilization declined 15.6% (P < .001). The percentage of all US hospitals performing TAR increased nearly 4-fold from 3.1% in 1991 to 12.6% in 2010, while the proportion performing AA remained relatively unchanged. LOS decreased dramatically from 8.7 days in 1991 to 2.3 days in 2010 in TAR and from 5.5 days to 3.2 days in AA (P < .001).
Conclusion:
Between 1991 and 2010, Medicare beneficiaries undergoing either TAR or AA became more medically complex. Both volume and per-capita utilization of TAR increased dramatically but remained nearly constant for AA. At the same time, mean hospital volume for both procedures remained low. Further research should be directed toward determining design, surgeon, and hospital variables that relate to optimal outcomes following TAR, which has become increasingly used for the treatment of ankle arthritis.
Level of Evidence:
Level III, comparative series.
Details
- Title: Subtitle
- Trends in the Use of Total Ankle Replacement and Ankle Arthrodesis in the United States Medicare Population
- Creators
- Andrew J Pugely - Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, IA, USAXin Lu - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USAAnnunziato Amendola - Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, IA, USAJohn J Callaghan - Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, IA, USAChristopher T Martin - Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, Iowa City, IA, USAPeter Cram - Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA, CADRE, Iowa City Veterans Administration Medical Center, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Foot & ankle international, Vol.35(3), pp.207-215
- DOI
- 10.1177/1071100713511606
- PMID
- 24177759
- ISSN
- 1071-1007
- eISSN
- 1944-7876
- Language
- English
- Date published
- 03/2014
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation; Internal Medicine
- Record Identifier
- 9984040577102771
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