Repeated surgeries can often be an indication of the failure of the initial operation. If the cause of this failure is identified, it’s possible that future reoperations could be avoided through the modification of procedures or devices. Not only do these reoperations result in costs to the patient, but they also burden the healthcare system. This is the context in which a new classification system for reoperations in end-stage ankle arthritis is proposed. The system is applied to analyze reoperation rates for two types of surgeries: ankle joint replacement and arthrodesis, using data from a multicenter database.
The study followed a total of 213 ankle arthrodeses and 474 total ankle replacements from 2002 to 2010. Reoperations were identified as part of the prospective cohort study. Operating reports were reviewed, and each reoperation was coded. To verify the reliability of this new coding system, six surgeons experienced in foot and ankle surgery were asked to assign a specific code to 62 blinded reoperations, on two separate occasions. The reliability was determined using intraclass correlation coefficients (ICCs) and proportions of agreement.
The results showed that out of a total of 687 procedures, 74.8% required no reoperation. By surgery type, 14.1% of ankle arthrodesis procedures and 30.2% of ankle replacement procedures required reoperation. The rate for reoperations surrounding the ankle joint was 9.9% for ankle arthrodesis versus 5.9% for ankle replacement. Reoperation rates within the ankle joint were 4.7% for ankle arthrodesis and 26.1% for ankle replacement. Overall, 0.9% of arthrodesis procedures required reoperation outside the initial operative site, versus 4.6% for total ankle replacement. The rate of reoperation due to deep infection was 0.9% for arthrodesis versus 2.3% for ankle replacement.
The reliability testing of the new coding system produced a mean ICC of 0.89 on the first read. The mean ICC for intraobserver reliability was 0.92. For interobserver, there was 87.9% agreement on the first read, and 87.5% agreement on the second. For the intra observer readings, 88.5% were in agreement.
The new coding system presented in this study was found to be reliable and may provide a more standardized, clinically useful framework for assessing reoperation rates and resource utilization than prior complication- and diagnosis-based classification systems, such as modifications of the Clavien Dindo System. Analyzing reoperations at the primary site may enable a better understanding of reasons for failure, and may therefore improve the outcomes of surgery in the future.
This study is a Level III, retrospective comparative cohort study based on prospectively collected data. This means that the study was designed to compare the outcomes of two different groups of patients (those who underwent ankle arthrodesis and those who underwent total ankle replacement) who were followed over time. The data was collected prospectively, meaning it was gathered in real-time as the events (in this case, the surgeries and any subsequent reoperations) occurred.
In conclusion, the new coding system for reoperations following total ankle replacement and ankle arthrodesis could be a valuable tool for healthcare professionals. It could help identify the causes of surgical failure, potentially leading to improved surgical procedures and devices, and ultimately better patient outcomes.
To read the full journal article, head to http://feedproxy.google.com/~r/FootAnkleInternational/~3/3EXetR_rS-U/1157