Pulmonary embolism and mortality following total ankle replacement: a data linkage study using the NJR data set

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Public Health

Background:

• Total ankle replacement (TAR) is an established procedure for end-stage ankle arthritis.
• Understanding post-operative complications such as mortality and pulmonary embolism (PE) is crucial for patient safety.
• Existing data on TAR-specific PE incidence and mortality is limited.

Purpose of the Study:

• To determine the 90-day and 1-year mortality rates following total ankle replacement (TAR).
• To assess the incidence of 90-day pulmonary embolism (PE) after TAR.
• To identify risk factors associated with PE after TAR.

Main Methods:

• A data-linkage study utilizing the UK National Joint Registry (NJR) and Hospital Episodes Statistics (HES) databases.
• Deterministic linkage of NJR and HES data for patient cohort identification.
• Analysis of HES data for PE occurrence within 90 days post-TAR and NJR data for mortality.

Main Results:

• The 90-day mortality rate following TAR was 0.13%, and the 1-year mortality rate was 0.72%.
• No deaths were directly attributed to PE.
• The 90-day PE incidence after primary TAR was 0.51%; only one PE occurred after revision surgery.
• Patients with a Charlson Comorbidity Index score > 0 had a 13-fold increased risk of PE (p=0.003).

Conclusions:

• Total ankle replacement (TAR) is associated with a low incidence of pulmonary embolism (PE).
• Multiple comorbidities represent a significant risk factor for PE development post-TAR.
• Risk stratification and proactive management of comorbidities are essential for improving patient outcomes after TAR.