A Propensity-Score Matched Analysis Comparing Outpatient and Short-Stay Hospitalization to Standard Inpatient Hospitalization Following Total Ankle Arthroplasty

Abstract Background Given the trend toward value-based care, there has been increased interest in minimizing hospital length of stay (LOS) after orthopaedic procedures. Outpatient total ankle arthroplasty (TAA) has become more popular in recent years; however, research on surgical outcomes of this procedure has been limited. This study sought to emply large sample, propensity-score matched analyses to assess the safety of outpatient and short-stay discharge pathways following TAA. Methods The ACS NSQIP database was used to identify 1,141 patients who underwent primary and revision TAA between 2007 and 2017. Propensity score matching was used to match patients based on several factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, and several comorbidities. The incidence of various 30-day complications were compared between the short and standard LOS groups to assess for any differences in short-term outcomes. Results A total of 892 patients were included in the final propensity score matched analysis, with 446 patients in each group. The short LOS group had a significantly lower rate of medical complications (0.2% vs. 2.5%, p = 0.006) and non-home discharge (1.3% vs. 12.1%, p 0.999), return to the OR (0.2% vs. 0.9%, p = 0.374), or mortality (0.7% vs. 0.0%, p > 0.249) between the short and standard LOS groups. Conclusions Outpatient and short-stay hospitalization had comparable safety to standard inpatient hospitalization after TAA. Outpatient or short-stay TAA should be considered for patients with low risk of short-term complications.