title: National Trends in Foot and Ankle Arthrodesis: 17-Year Analysis of the National Survey of Ambulatory Surgery and National Hospital Discharge Survey.
abstract: Foot and ankle arthrodesis reliably reduces pain and functional disability among patients with arthritis and deformity. Since its introduction in 1953, improvements in surgical technique have enhanced the outcomes and reduced complications. However, little is known regarding US national trends of foot and ankle arthrodesis. The present study sought to use the most recently available Centers for Disease Control and Prevention data to investigate changes in the usage of inpatient and ambulatory foot and ankle arthrodesis. Cases of foot and ankle arthrodesis were identified using the National Hospital Discharge Survey and National Survey of Ambulatory Surgery, and the data were analyzed for trends in demographics, treatment, and usage. From 1994 to 2006, the population-adjusted rates of foot and ankle arthrodeses increased by 146% (8.2/100,000 capita to 20.2/100,000 capita). The number of outpatient arthrodeses performed with arthroscopic assistance increased by 858%. The population-adjusted rate of outpatient and inpatient procedures increased by 415% and 17%, respectively. The gender-adjusted rates increased by 59% for males and 209% for females. The age-adjusted rates increased among patients >35 years old in both settings. The use of peripheral nerve blocks during ambulatory procedures increased from 3.3% to 10.1%. Private insurance was the largest compensator. In conclusion, the rate of foot and ankle arthrodesis increased dramatically from 1990 to 2007 using the most up-to-date publicly available data. Knowledge of these national practice patterns could aid policy-makers and surgeons in appropriately allocating healthcare resources to ensure quality patient care.
authors.affiliation: Resident, Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Best
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL. Electronic address: l.buller@med.miami.edu.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Miranda
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000706:statistics & numerical data*; D005260:Female; D033023:Foot Joints / Q000601:surgery*; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
keywords: ankle arthrodesis; ankle fusion; epidemiology; hindfoot; metatarsophalangeal; midfoot; outpatient surgery