Study of Total Ankle Arthroplasty and Ankle Arthrodesis Complications and Costs Based on Surgeon Specialty

Total ankle arthroplasty (TAA) and ankle arthrodesis (AA) remain viable treatment options for end-stage ankle arthritis. Both procedures are performed by orthopaedic surgeons and podiatric surgeons. The literature comparing outcomes based on surgeon specialty is sparse. In this study, we studied postoperative outcomes for both TAA and AA based on surgeon specialty in a Medicare cohort of both fee-for-service and health maintenance organization claims. Our primary outcome was surgical complications, and secondary outcome was 90-day episode-of-care costs, based on surgeon specialty.

We performed a retrospective analysis of Medicare claims from 2016 to 2021 for beneficiaries aged 65 years or older who underwent either TAA or AA. Surgeon specialty was identified using specialty taxonomy codes submitted with claims. Multivariate regressions were performed to compare complication rates and costs between specialty, adjusted for patient age, sex, race, Charlson Comorbidity Index, dementia, year, presence of a surgeon assistant, surgery setting, and Medicare plan type. To account for inflation, costs from prior years were inflated to 2021 equivalents based on the gross domestic product (GDP) implicit price deflator.

Adjusted infection rates were higher among podiatric surgeons compared with orthopaedic surgeons for both TAA and AA. For TAA, the difference was +3.7 percentage points (ppts; 95% CI: 2.5-4.9) at 90 days and +4.1 ppts (95% confidence interval [CI]: 2.7-5.5) at 1 year. For AA, the difference was +3.8 ppts (95% CI: 2.1-5.5) at 90 days and +5.3 ppts (95% CI: 3.1-7.5) at 1 year. Most episode-of-care costs were higher when procedures were performed by podiatric surgeons.

Among Medicare beneficiaries, we observed an increased risk of postoperative complications-most notably infection-among podiatric surgeons relative to orthopaedic surgeons for both TAA and AA. Higher costs were seen with podiatric surgeons, though the clinical significance of these cost findings is unclear. With an aging population and expanding utilization of TAA, further investigations should continue to explore the impact of surgeon specialty on postoperative complication rates to best identify the optimal care for patients with ankle arthritis.

Level III, therapeutic. See Instructions for Authors for a complete description of levels of evidence.