The Regionalization of Total Ankle Arthroplasties and Ankle Fusions in New York State: A 10-Year Comparative Analysis.
BACKGROUND
Total ankle arthroplasty (TAA) provides an alternative to ankle fusion (AF). The purpose of this study is to (1) determine the extent of TAA regionalization, as well as examine the growth of TAA performed at high-, medium-, and low-volume New York State institutions and (2) compare this regionalization and growth with AF.


METHODS
The New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 737 primary TAA and 7453 AF from 2005 to 2014. The volume of TAA and AF surgery in New York State was mapped according to patient and hospital 3-digit zip code.


RESULTS
The number of TAA per year grew 1500% (from 11 to 177) from 2005 to 2014, while there was a 35.6% reduction (from 895 to 576) in yearly AF procedures. TAA recipients were widely distributed throughout the state, while TAA procedures were regionalized to a few select metropolitan centers. AF procedures were performed more uniformly than TAA. The number of TAA has continued to increase at high- (15 to 91) and medium-volume (14 to 67) institutions where it has decreased at low-volume institutions (44 to 19).


CONCLUSIONS
The increased utilization of TAA is attributed to relatively few high-volume centers located in major metropolitan centers.


METHODS
Level IV: well-designed case-control or cohort studies.
NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY.
John A
JA
Buza
NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY.
James X
JX
Liu
NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY.
Jeffrey
J
Jancuska
NYU Langone Medical Center, Hospital for Joint Diseases, New York, NY.
Joseph A
JA
Bosco
D000843:Ankle Joint / Q000601:surgery*; D001174:Arthrodesis / Q000706:statistics & numerical data*; D058737:Arthroplasty, Replacement, Ankle / Q000706:statistics & numerical data*; D003695:Delivery of Health Care; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D009518:New York; D012189:Retrospective Studies; D016896:Treatment Outcome
ankle fusion; centralization; health care access; regionalization; total ankle arthroplasty