Safety and Effectiveness of Outpatient Total Ankle Arthroplasty

Background: Total ankle arthroplasty (TAA) is a surgical procedure commonly reserved for patients suffering from symptomatic end-stage ankle arthritis. As the number of TAAs increases, so does the associated economic burden. Given these economic constraints, there has been interest in the feasibilit...

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Autores principales:	Shahin Kayum MD, Sahil Kooner MD, Ryan M. Khan BA, MSc, CCRP, Mansur Halai BSc(Hons), MBChB, Adam Awoke BSc, Asa Kanani BSc, Spencer Montgomery, Alexander Meldrum, Timothy R. Daniels MD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/c843571498d248fa8ceccf69b9d88f4f
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spelling	oai:doaj.org-article:c843571498d248fa8ceccf69b9d88f4f2021-12-02T06:33:19ZSafety and Effectiveness of Outpatient Total Ankle Arthroplasty2473-011410.1177/24730114211057888https://doaj.org/article/c843571498d248fa8ceccf69b9d88f4f2021-11-01T00:00:00Zhttps://doi.org/10.1177/24730114211057888https://doaj.org/toc/2473-0114Background: Total ankle arthroplasty (TAA) is a surgical procedure commonly reserved for patients suffering from symptomatic end-stage ankle arthritis. As the number of TAAs increases, so does the associated economic burden. Given these economic constraints, there has been interest in the feasibility of outpatient TAA. The purpose of this study is to evaluate the safety, efficacy, and satisfaction of patients undergoing outpatient TAA. Methods: This is a retrospective case series of consecutive patients who underwent outpatient TAA from July 2018 to June 2019. Inclusion criteria included any patient undergoing a primary TAA in the outpatient setting. This was defined as discharge on the same day of surgery or within 12 hours of surgery. All surgeries were completed by a single experienced surgeon through an anterior approach using the Cadence Total Ankle System. Prior to surgery, all patients received a popliteal nerve block. Patients were then discharged home with oral analgesic and a popliteal nerve catheter, which they removed after 48 hours. The primary outcome of interest was postoperative pain control, which was measured using a numeric scale. Secondary outcomes included complication rate, readmission rate, and patient satisfaction. A review of the current literature was then completed to supplement our results. Results: In total, 41 patients were included in our analysis. In terms of the primary outcome, the average numeric scale score was 1.98, indicating excellent pain control. Additionally, nearly all 41 patients stated they were very satisfied with their postoperative pain control regimen. In terms of secondary outcomes, the majority of patients stated they were satisfied with discharge on the same day as surgery. There were no readmissions or major complications in our outpatient TAA cohort. When asked if they would recommend the care they experienced to a friend with the same condition, 95% of patients said that they would recommend this care pathway. Our literature review included 5 original studies, which were all retrospective level IV studies. These studies uniformly demonstrated the safety and efficacy of outpatient TAA. Conclusions: The results of our study demonstrate the outpatient TAA is associated with excellent pain control using a multidisciplinary pain approach. The use of standardized outpatient postoperative pathways was effective in preventing readmissions and complications, while still resulting in high patient satisfaction scores. A review of the literature complemented our results, as there are largely no significant differences between outpatient and inpatient TAA. Level of Evidence: Level IV, case series.Shahin Kayum MDSahil Kooner MDRyan M. Khan BA, MSc, CCRPMansur Halai BSc(Hons), MBChBAdam Awoke BScAsa Kanani BScSpencer MontgomeryAlexander MeldrumTimothy R. Daniels MDSAGE PublishingarticleOrthopedic surgeryRD701-811ENFoot & Ankle Orthopaedics, Vol 6 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Shahin Kayum MD Sahil Kooner MD Ryan M. Khan BA, MSc, CCRP Mansur Halai BSc(Hons), MBChB Adam Awoke BSc Asa Kanani BSc Spencer Montgomery Alexander Meldrum Timothy R. Daniels MD Safety and Effectiveness of Outpatient Total Ankle Arthroplasty
description	Background: Total ankle arthroplasty (TAA) is a surgical procedure commonly reserved for patients suffering from symptomatic end-stage ankle arthritis. As the number of TAAs increases, so does the associated economic burden. Given these economic constraints, there has been interest in the feasibility of outpatient TAA. The purpose of this study is to evaluate the safety, efficacy, and satisfaction of patients undergoing outpatient TAA. Methods: This is a retrospective case series of consecutive patients who underwent outpatient TAA from July 2018 to June 2019. Inclusion criteria included any patient undergoing a primary TAA in the outpatient setting. This was defined as discharge on the same day of surgery or within 12 hours of surgery. All surgeries were completed by a single experienced surgeon through an anterior approach using the Cadence Total Ankle System. Prior to surgery, all patients received a popliteal nerve block. Patients were then discharged home with oral analgesic and a popliteal nerve catheter, which they removed after 48 hours. The primary outcome of interest was postoperative pain control, which was measured using a numeric scale. Secondary outcomes included complication rate, readmission rate, and patient satisfaction. A review of the current literature was then completed to supplement our results. Results: In total, 41 patients were included in our analysis. In terms of the primary outcome, the average numeric scale score was 1.98, indicating excellent pain control. Additionally, nearly all 41 patients stated they were very satisfied with their postoperative pain control regimen. In terms of secondary outcomes, the majority of patients stated they were satisfied with discharge on the same day as surgery. There were no readmissions or major complications in our outpatient TAA cohort. When asked if they would recommend the care they experienced to a friend with the same condition, 95% of patients said that they would recommend this care pathway. Our literature review included 5 original studies, which were all retrospective level IV studies. These studies uniformly demonstrated the safety and efficacy of outpatient TAA. Conclusions: The results of our study demonstrate the outpatient TAA is associated with excellent pain control using a multidisciplinary pain approach. The use of standardized outpatient postoperative pathways was effective in preventing readmissions and complications, while still resulting in high patient satisfaction scores. A review of the literature complemented our results, as there are largely no significant differences between outpatient and inpatient TAA. Level of Evidence: Level IV, case series.
format	article
author	Shahin Kayum MD Sahil Kooner MD Ryan M. Khan BA, MSc, CCRP Mansur Halai BSc(Hons), MBChB Adam Awoke BSc Asa Kanani BSc Spencer Montgomery Alexander Meldrum Timothy R. Daniels MD
author_facet	Shahin Kayum MD Sahil Kooner MD Ryan M. Khan BA, MSc, CCRP Mansur Halai BSc(Hons), MBChB Adam Awoke BSc Asa Kanani BSc Spencer Montgomery Alexander Meldrum Timothy R. Daniels MD
author_sort	Shahin Kayum MD
title	Safety and Effectiveness of Outpatient Total Ankle Arthroplasty
title_short	Safety and Effectiveness of Outpatient Total Ankle Arthroplasty
title_full	Safety and Effectiveness of Outpatient Total Ankle Arthroplasty
title_fullStr	Safety and Effectiveness of Outpatient Total Ankle Arthroplasty
title_full_unstemmed	Safety and Effectiveness of Outpatient Total Ankle Arthroplasty
title_sort	safety and effectiveness of outpatient total ankle arthroplasty
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/c843571498d248fa8ceccf69b9d88f4f
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Safety and Effectiveness of Outpatient Total Ankle Arthroplasty

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