Background/Purpose:   It is not known whether there are rural-urban disparities in Total Ankle Arthroplasty (TAA), given that TAA is a relatively new procedure and is an elective procedure.  Our objective was to assess whether patient’s residence (rural vs. urban) was associated with any disparities in TAA utilization and TAA outcomes.  We hypothesized the utilization rates will be lower and poor outcomes more common in rural residents, compared to urban residents.  

Methods: We used the Nationwide Inpatient Sample (NIS) from 2003-11 to compare utilization and outcomes (post-arthroplasty discharge disposition, length of hospitalization and mortality) by rural vs. urban residence. 

Results: 10,833 patients in urban and 3,324 patients in rural area underwent TAA.  Compared to rural residents, urban residents had: lower mean age, 62.4 vs. 61.8 (p <0.0001), higher percent of women, 49% vs. 56% (p=0.0008) and lower proportion of Whites, 93% vs. 86% (p=0.0005).  There were rural-urban disparities in TAA utilization in 2003 (0.32 vs. 0.39/100,000; p=0.021), but not in 2011 (1.19 vs. 1.17/100,00; p=0.80).  TAA outcomes did not differ by rural vs. urban residence: (1) 11.3% rural vs. 14.2% urban residents were discharged to an inpatient facility (p=0.098); (2) length of hospital stay above the median stay, 44.8% vs. 42.2% (p=0.30); and (3) mortality, 0.2% vs. 0.1%, respectively (p=0.81).  Multivariable-adjusted logistic regression models did not show any significant differences in discharge to home, length of stay or mortality, by residence.    

Conclusion: Our study demonstrated no evidence of rural-urban differences in TAA outcomes.  The rural-urban differences in TAA utilization noted in 2003 were no longer significant in 2011.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/rural-residence-does-not-impact-total-ankle-arthroplasty-utilization-and-outcomes/