TY - JOUR
T1 - Trends in the use of total ankle replacement and ankle arthrodesis in the United States medicare population
AU - Pugely, Andrew J.
AU - Lu, Xin
AU - Amendola, Annunziato
AU - Callaghan, John J.
AU - Martin, Christopher T.
AU - Cram, Peter
N1 - Funding Information:
The authors declared receipt of the following financial support for the research, authorship, and/or publication of this article: Dr Cram is supported by a K24 award from NIAMS (AR062133) and by the Department of Veterans Affairs. This work is also funded in-part by R01 AG033035 from NIA at the NIH. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. No funding source had a role in the design or conduct of the study; data collection, management, analysis, or interpretation; or the preparation, review, or approval of the manuscript.
Funding Information:
Dr Cram is supported by a K24 award from NIAMS (AR062133) and by the Department of Veterans Affairs. This work is also funded in part by R01 HL085347 from the National Heart, Lung, and Blood Institute and R01 AG033035 from National Institute on Aging at the National Institutes of Health. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. The funding sources had no role in the analyses or drafting of this article. None of the authors have any conflicts of interest. Dr Cram has received consulting fees from The Consumers Union (publisher of Consumer Reports Magazine ) and Vanguard Health Inc for work advice on quality improvement initiatives.
PY - 2014/3
Y1 - 2014/3
N2 - Background: Total ankle replacement (TAR) has gained acceptance as an alternative to traditional ankle arthrodesis (AA)for end-stage ankle arthritis. Little is known about long-term trends in volume, utilization, and patient characteristics. Theobjective of this study was to use longitudinal data to examine temporal trends in TAR and AA.Methods: We identified all United States fee-for-service Medicare beneficiaries who underwent TAR and AA between1991 and 2010 (n = 5871 and 29 532, respectively). We examined changes in patient demographics and comorbidity,nationwide and hospital volume, per capita utilization, and length of stay (LOS).Results: Between 1991 and 2010, both TAR and AA patients had modest shifts in characteristics, with higher rates ofdiabetes and obesity. Overall, TAR Medicare volume increased by more than 1000% from 72 procedures in 1991 to 888in 2010, while per-capita standardized utilization increased 670.8% (P < .001). AA volume increased 35.8% from 1167procedures in 1991 to 1585 in 2010, while per-capita standardized utilization declined 15.6% (P < .001). The percentageof all US hospitals performing TAR increased nearly 4-fold from 3.1% in 1991 to 12.6% in 2010, while the proportionperforming AA remained relatively unchanged. LOS decreased dramatically from 8.7 days in 1991 to 2.3 days in 2010 inTAR and from 5.5 days to 3.2 days in AA (P < .001).Conclusion: Between 1991 and 2010, Medicare beneficiaries undergoing either TAR or AA became more medicallycomplex. Both volume and per-capita utilization of TAR increased dramatically but remained nearly constant for AA. Atthe same time, mean hospital volume for both procedures remained low. Further research should be directed towarddetermining design, surgeon, and hospital variables that relate to optimal outcomes following TAR, which has becomeincreasingly used for the treatment of ankle arthritis.Level of Evidence: Level III, comparative series.
AB - Background: Total ankle replacement (TAR) has gained acceptance as an alternative to traditional ankle arthrodesis (AA)for end-stage ankle arthritis. Little is known about long-term trends in volume, utilization, and patient characteristics. Theobjective of this study was to use longitudinal data to examine temporal trends in TAR and AA.Methods: We identified all United States fee-for-service Medicare beneficiaries who underwent TAR and AA between1991 and 2010 (n = 5871 and 29 532, respectively). We examined changes in patient demographics and comorbidity,nationwide and hospital volume, per capita utilization, and length of stay (LOS).Results: Between 1991 and 2010, both TAR and AA patients had modest shifts in characteristics, with higher rates ofdiabetes and obesity. Overall, TAR Medicare volume increased by more than 1000% from 72 procedures in 1991 to 888in 2010, while per-capita standardized utilization increased 670.8% (P < .001). AA volume increased 35.8% from 1167procedures in 1991 to 1585 in 2010, while per-capita standardized utilization declined 15.6% (P < .001). The percentageof all US hospitals performing TAR increased nearly 4-fold from 3.1% in 1991 to 12.6% in 2010, while the proportionperforming AA remained relatively unchanged. LOS decreased dramatically from 8.7 days in 1991 to 2.3 days in 2010 inTAR and from 5.5 days to 3.2 days in AA (P < .001).Conclusion: Between 1991 and 2010, Medicare beneficiaries undergoing either TAR or AA became more medicallycomplex. Both volume and per-capita utilization of TAR increased dramatically but remained nearly constant for AA. Atthe same time, mean hospital volume for both procedures remained low. Further research should be directed towarddetermining design, surgeon, and hospital variables that relate to optimal outcomes following TAR, which has becomeincreasingly used for the treatment of ankle arthritis.Level of Evidence: Level III, comparative series.
KW - CMS
KW - Medicare
KW - ankle arthrodesis
KW - ankle fusion
KW - outcomes
KW - total ankle
KW - utilization
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U2 - 10.1177/1071100713511606
DO - 10.1177/1071100713511606
M3 - Article
C2 - 24177759
AN - SCOPUS:84896744090
SN - 1071-1007
VL - 35
SP - 207
EP - 215
JO - Foot and Ankle International
JF - Foot and Ankle International
IS - 3
ER -