Risk Factors and Complications in Tibiotalocalcaneal (TTC) Arthrodesis: A Nationwide Database Comparison Between Traumatic Ankle Fracture and Osteoarthritis.
Abhiram Dawar, Gnaneswar Chundi, David B Ahn, Avani A Chopra, Jonathan Lopez, Matthew Montani, Sheldon S Lin, Tuckerman Jones
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引用次数: 0
Abstract
Background: Tibiotalocalcaneal (TTC) arthrodesis is an established treatment for osteoarthritis (OA), offering stabilization and earlier weightbearing. However, its role in managing traumatic fractures (TFs) remains controversial because of higher risks of complications. This study aimed to compare complication rates, readmissions, and predictors of adverse outcomes in TTC arthrodesis performed for OA vs TF using a national database.
Methods: A retrospective cohort study was conducted using the Nationwide Readmissions Database (2016-2021). Patients undergoing TTC arthrodesis were identified via International Classification of Diseases, Tenth Revision (ICD-10) codes and stratified by indication (OA or TF). Primary outcomes included complication rates, 30- and 90-day readmissions, and revision surgeries. Multivariable logistic regression identified independent predictors of complications. Propensity score matching (PSM) was performed to account for baseline differences.
Results: TF cases exhibited significantly higher complication rates (54.5% vs 16.0%, P < .001), including malunion (11% vs 2%, P < .001) and cellulitis (5% vs 1%, P < .001). Readmission rates were also elevated in TF patients at 30 days (17% vs 3%, P < .001) and 31-90 days (14% vs 4.8%, P < .001). Logistic regression identified chronic kidney disease, diabetes, and obesity as independent predictors of complications. PSM confirmed these findings, demonstrating significantly higher rates of complications and readmissions in TF patients.
Discussion: Findings indicate that TTC arthrodesis for TF is associated with higher risks of complications and readmissions compared with OA, attributable to acute injury characteristics and surgical complexity. Chronic comorbidities further exacerbate these risks. Optimizing perioperative management and timing of surgery in TF patients may mitigate complications. This study highlights the need for individualized care strategies to improve outcomes in TTC arthrodesis for trauma.
Level of evidence: Level III, therapeutic: case-control study.
背景：胫距跟骨（TTC）关节融合术是骨关节炎（OA）的一种成熟治疗方法，提供稳定和早期负重。然而，由于其并发症风险较高，其在创伤性骨折（TFs）治疗中的作用仍存在争议。本研究旨在通过国家数据库比较OA和TF患者行TTC关节融合术的并发症发生率、再入院率和不良预后预测因素。方法：使用全国再入院数据库（2016-2021）进行回顾性队列研究。接受TTC关节融合术的患者通过国际疾病分类第十版（ICD-10）代码进行鉴定，并根据适应症（OA或TF）进行分层。主要结局包括并发症发生率、30天和90天再入院率以及翻修手术。多变量逻辑回归确定了并发症的独立预测因素。采用倾向评分匹配（PSM）来解释基线差异。结果：TF患者并发症发生率（54.5%比16.0%,P < 0.001）显著高于TF患者（11%比2%，P < 0.001）和蜂窝织炎（5%比1%，P < 0.001）。TF患者在30天（17% vs 3%, P < 0.001）和31-90天（14% vs 4.8%, P < 0.001）再入院率也有所升高。Logistic回归发现慢性肾脏疾病、糖尿病和肥胖是并发症的独立预测因素。PSM证实了这些发现，表明TF患者的并发症和再入院率明显更高。讨论：研究结果表明，由于急性损伤特征和手术复杂性，与OA相比，TTC关节融合术治疗TF的并发症和再入院风险更高。慢性合并症进一步加剧了这些风险。优化TF患者的围手术期管理和手术时机可以减轻并发症。本研究强调需要个性化护理策略来改善创伤TTC关节融合术的预后。证据等级：III级，治疗性：病例对照研究。
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