Longer operative time increases the risk of a prolonged length of stay following primary total ankle arthroplasty.

Improving the safety profile of total ankle arthroplasty (TAA) is essential to expand its indications and global use. Identifying risk factors for complications can enhance preoperative patient optimization and surgical decision-making. While longer surgical times are known to increase perioperative risks in many orthopedic procedures, this has not been extensively studied in TAA. This study aims to determine whether longer operative times increase the risk of 30-day complications, readmissions, nonhome discharge, and prolonged length of stay. This retrospective study utilized 2015-2020 data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Primary TAA patients were divided into two cohorts based on operative time: ≥ 150 minutes or < 150 minutes. Patient characteristics and complications were compared using bivariate and multivariate analyses, including Pearson's Chi Squared test and logistic regression. Of 1,524 primary TAA patients, 676 had an operative time ≥150 minutes, and 848 had an operative time <150 minutes. After adjusting for covariates, longer operative time (≥150 minutes) was an independent risk factor for a prolonged length of stay (≥2 days) (OR 2.157 [95 % CI 1.732-2.686], p < 0.0001). However, longer operative time did not independently increase the risk of medical complications, readmissions, or nonhome discharge (p > 0.05). Surgeons should be aware of the increased risk of prolonged hospital stay with longer operative times in primary TAA and consider strategies to minimize surgical time.