DIFFERENTIAL UTILIZATION PATTERNS OF TOTAL ANKLE ARTHROPLASTY VERSUS ARTHRODESIS: A NATIONAL AMBULATORY DATABASE ANALYSIS
Notice bibliographique
Résumé
End-stage ankle osteoarthritis is a debilitating condition that can be treated surgically with ankle arthrodesis (AA), or more recently, total ankle arthroplasty TAA. Several clinical factors have been implicated in the choice of one treatment approach over the other; however, the effect of demographic, hospital, and socioeconomic factors on this decision remains poorly characterized. The current study aimed to estimate the relative nationwide utilization of these two procedures and delineate patient and hospital factors that are associated with the selection of TAA versus AA for ankle osteoarthritis. TAA and AA procedures performed for ankle osteoarthritis were identified based on CPT and ICD-10 codes in the Nationwide Ambulatory Surgery Sample (NASS) Database. Instances with avascular necrosis of the talus, Charcot neuroarthropathy, lower extremity vascular insufficiency, limb neuropathy, varus or valgus deformity of the ankle, or osteoporosis with concurrent ankle fracture were excluded from the analysis. Cases were weighted using nationally representative discharge weights. Univariate analyses and a combine multiple logistic regression model were used to compare demographic, hospital, and socioeconomic related factors associated with TAA versus AA. In total, 6,577 cases were identified, which represents 9,072 cases after weighting. Of these, TAA was performed for 2,233 (24.6%). Based on the logistic regression model, several factors were associated with increased utilization of TAA versus AA. With regards to patient factors, older patients were more likely to undergo TAA (per decade, Odds Ratio [OR] of TAA = 1.24; p < 0.001), as well as females (OR = 1.28; p < 0.001). Conversely, patients with a higher comorbidity burden were less likely to receive TAA over AA (OR = 0.92; p < 0.001) With regards to socioeconomic factors, urban teaching (OR = 1.62; p < 0.001) and urban non-teaching (OR = 1.42; p = 0.004), hospitals were significantly more likely to utilize TAA compared to rural hospitals. Similarly, privately insured patients (OR = 3.45; p < 0.001) and those with a median household income of $71,000 or more (OR = 1.74; p < 0.001) were also more likely to receive TAA over AA. Lastly, private, not-for-profit (OR = 1.64; p < 0.001) and private, investor-owned hospitals (OR = 1.73; p < 0.001) were significantly more likely to offer TAA over AA. Using a large nationally representative cohort, the current data revealed that only 24.6% of operatively treated cases of end-stage ankle osteoarthritis are treated with TAA. While associations between patient age, comorbidity status and TAA utilization align with functional expectations, socioeconomic and hospital-level associations suggest that other factors may systematically influence surgical treatment type of ankle osteoarthritis. Surgeons should be conscious of these influences when determining the optimal treatment for their patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,004 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».