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Increased Risk of 90-Day Surgical-Site Infection and Hospital Readmission but Not Reoperation After Open Arthrotomy When Compared With Arthroscopy for Septic Ankle Arthritis

Published:January 27, 2022DOI:https://doi.org/10.1016/j.arthro.2022.01.022

      Purpose

      To compare the rates of reoperation and 90-day perioperative complications between open arthrotomy and arthroscopy for the treatment of septic ankle arthritis using a national all-payer claims database.

      Methods

      Patients with a diagnosis of septic ankle arthritis who underwent irrigation and debridement through arthroscopy or arthrotomy were identified in a national data set from 2015-2020 through an all-payer claims database. Demographic and comorbidity characteristics including age, sex, infectious etiologies, and Elixhauser comorbidities were obtained. The rate of reoperation, defined as a proxy for failure of initial intervention, was the primary outcome. Secondary outcomes including readmissions, surgical-site infections, amputations, wound complications, and 90-day medical complications were compared between the 2 cohorts.

      Results

      In total, 168 patients undergoing arthroscopy and 794 patients undergoing arthrotomy for septic ankle arthritis were identified. There were no significant differences in reoperation rates between patients who underwent open arthrotomy and those who underwent arthroscopy (P = .997). However, the rates of surgical-site infection (P = .014) and hospital readmission (P < .001) were significantly higher in the open arthrotomy cohort compared with the arthroscopy cohort.

      Conclusions

      Although there was no significant difference in reoperation rates between arthroscopic and open irrigation and debridement for the treatment of septic ankle arthritis, this study showed significantly higher odds of surgical-site infection and hospital readmission in patients who underwent open arthrotomy when compared with arthroscopy. Case-specific patient and technical considerations should guide the surgical decision-making process to limit secondary complications because this study exemplifies similar reoperation rates between the 2 surgical modalities.

      Level of Evidence

      Level III, nonrandomized cohort analysis.
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