Economic Analysis and Clinical Outcomes of Short-Stay Versus Inpatient Total Ankle Replacement Surgery

Craig C. Akoh, Amanda N. Fletcher, Jie Chen, Juanto Wang, Samuel A. Adams, James K. DeOrio, James A. Nunley, Mark E. Easley

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: We aimed to perform an economic analysis and compare the clinical outcomes between inpatient and short-stay designation total ankle replacement (TAR). Methods: We performed a retrospective study on 178 consecutive patients undergoing primary inpatient versus short-stay designation TAR during the 2016 and 2017 fiscal years. Patient demographics, concomitant procedures, perioperative complications, patient-reported outcomes, and perioperative costs were collected. Results: The mean age of our cohort was 62.5 ± 9.6 years (range, 30-88 years), with a significant difference in age (64.1 vs 58.5 years) (P =.005) and Charlson Comorbidity Index (3.3 ± 1.9 vs 2.3 ± 1.4; P =.002) for the inpatient and short-stay designation groups, respectively. At a mean follow-up of 29.6 ± 11.8 months (range, 12-52.3 months), there was no difference in complications between groups (P =.97). The inpatient designation TAR group had a worse baseline Short Musculoskeletal Functional Assessment (SMFA) function score (76.1; 95% CI, 70.5-81.6) than the short-stay designation TAR group (63.9; 95% CI, 52.5-75.3) while achieving similar final postoperative SMFA function scores for the inpatient (55.2; 95% CI, 51.1-59.2) and short-stay (56.2; 95% CI, 48.2-64.2) designation TAR groups (P >.05). However, the inpatient designation TAR group showed a significantly greater mean improvement in SMFA function score (20.9; 95% CI, 19.4-22.4) compared with the short-stay designation TAR group (7.7; 95% CI, 3.7-11.1) (P =.0442). The total direct cost was significantly higher for the inpatient designation group ($15 340) than the short-stay designation group ($13 002) (P <.001). Conclusion: While inpatient designation TARs were more comorbid, short-stay designation TARs were associated with a 15.5% reduction in perioperative costs, comparable complication rates, and similar final postoperative patient-reported outcome scores compared with inpatient TARs. Level of Evidence: Level III, retrospective comparative study.

Original languageEnglish (US)
Pages (from-to)96-106
Number of pages11
JournalFoot and Ankle International
Issue number1
StatePublished - Jan 2021
Externally publishedYes


  • ambulatory surgery
  • clinical outcomes
  • cost analysis
  • inpatient surgery
  • outpatient surgery
  • total ankle replacement

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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