title: Does rural residence impact total ankle arthroplasty utilization and outcomes?
abstract: The objective of this study was to compare total ankle arthroplasty (TAA) utilization and outcomes by patient residence. We used the Nationwide Inpatient Sample (NIS) from 2003 to 2011 to compare utilization and outcomes (post-arthroplasty discharge disposition, length of hospitalization, and mortality) by rural vs. urban residence. Ten thousand eight hundred thirty-three patients in urban and 3,324 patients in rural area underwent TAA. Compared to rural residents, urban residents had: lower mean age, 62.4 vs. 61.8 years (p < 0.0001); higher percent of women, 49 vs. 56 % (p = 0.0008); and lower proportion of Whites, 93 vs. 86 % (p = 0.0005). There were rural-urban disparities in TAA utilization in 2003 (0.32 vs. 0.39/100,000; p = 0.021), but not in 2011 (1.19 vs. 1.17/100,00; p = 0.80). TAA outcomes did not differ by rural vs. urban residence: (1) 11.3 % rural vs. 14.2 % urban residents were discharged to an inpatient facility (p = 0.098); (2) length of hospital stay above the median stay, was 44.8 vs. 42.2 % (p = 0.30); and (3) mortality was 0.2 vs. 0.1 %, respectively (p = 0.81). Multivariable-adjusted logistic regression models did not show any significant differences in discharge to home, length of stay, or mortality, by residence. Our study demonstrated an absence of any evidence of rural-urban differences in TAA outcomes. The rural-urban differences in TAA utilization noted in 2003 were no longer significant in 2011.
authors.affiliation: Medicine Service and Center for Surgical Medical Acute care Research and Transitions (C-SMART), Birmingham VA Medical Center, Birmingham, AL, USA. Jasvinder.md@gmail.com.|Department of Medicine at the School of Medicine and Division of Epidemiology at the School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA. Jasvinder.md@gmail.com.|Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA. Jasvinder.md@gmail.com.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Rekha
authors.initials: R
authors.lastname: Ramachandaran
mesh_terms: D000368:Aged; D058737:Arthroplasty, Replacement, Ankle / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Outcomes; Residence; Rural; Total ankle arthroplasty; Urban; Utilization