Emergency Department Utilization Following Primary Versus Revision Ankle Arthrodesis: A Propensity-Matched Analysis

Revision ankle arthrodesis (AA) is traditionally considered more technically complex and associated with increased postoperative morbidity compared with primary AA. Emergency department (ED) utilization has emerged as an important measure of postoperative healthcare utilization, yet direct comparisons between primary and revision AA are limited.

To compare 1-year postoperative ED utilization following primary vs revision AA STUDY DESIGN: Retrospective comparative cohort study METHODS: Following institutional review board approval, patients who underwent AA between 2015 and 2025 at a single institution were identified and stratified into primary and revision cohorts. ED utilization within 1 year postoperatively was evaluated. Patients were matched 1:1 using propensity score matching based on age, body mass index, sex, smoking status, diabetes, and medical comorbidities. Risk differences, risk ratios, and odds ratios with 95% confidence intervals (CIs) were calculated. Timing and indications for ED presentation were assessed.

A total of 463 patients were included (391 primary, 72 revision). After propensity matching, 68 revision patients were matched to 68 primary patients with adequate covariate balance. One-year ED utilization occurred in 22 of 68 primary AA patients (32.4%) compared with 6 of 68 revision AA patients (8.8%). Revision AA was associated with a lower risk of ED utilization (risk difference, -23.5%; 95% CI, -36.5% to -10.5%; risk ratio, 0.27; 95% CI, 0.12-0.63; odds ratio, 0.20; 95% CI, 0.08-0.54). Infection was the most common indication for ED presentation in both cohorts.

In this propensity-matched analysis, revision AA was not associated with increased postoperative ED utilization and demonstrated lower observed ED utilization than primary AA. Infection remained the leading cause of postoperative ED presentation.