Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study
Background: Closed wound drainage has been extensively studied in the hip and knee arthroplasty literature with equivocal results on its clinical benefits. Although also used in orthopaedic surgeries like ankle arthrodesis and ankle arthroplasty, large-scale data are currently lacking on utilization...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-08-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/24730114221119735 |
| _version_ | 1811282851371417600 |
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| author | Jeffrey Okewunmi BS Jimmy J. Chan MD Jashvant Poeran MD, PhD Nicole Zubizarreta MPH Madhu Mazumdar PhD Ettore Vulcano MD |
| author_facet | Jeffrey Okewunmi BS Jimmy J. Chan MD Jashvant Poeran MD, PhD Nicole Zubizarreta MPH Madhu Mazumdar PhD Ettore Vulcano MD |
| author_sort | Jeffrey Okewunmi BS |
| collection | DOAJ |
| description | Background: Closed wound drainage has been extensively studied in the hip and knee arthroplasty literature with equivocal results on its clinical benefits. Although also used in orthopaedic surgeries like ankle arthrodesis and ankle arthroplasty, large-scale data are currently lacking on utilization patterns and real-world effectiveness. We, therefore, aimed to address this research gap in this distinct surgical cohort using national claims data. Methods: Using the Premier Healthcare claims database from 2006 to 2016, ankle arthrodesis (n=10,085) and ankle arthroplasty (n=4,977) procedures were included. The main effect was drain use, defined by detailed billing descriptions. Outcomes included blood transfusion, 90-day readmission, and length and cost of hospitalization. Mixed-effects models measured associations between drain use and outcomes. Odds ratios (OR, or % change), 95% CIs, and P values are reported. Results: Overall, drains were used in 11% (n=1,074) and 15% (n=755) of ankle arthrodesis and ankle arthroplasty procedures, respectively. Drain use dramatically decreased over the years in both surgery types: from 14% to 6% and 24% to 7% between 2006 and 2016, for arthrodesis and ankle arthroplasty procedures, respectively. After adjustment for relevant covariates, drain use was associated with increased odds of blood transfusion in ankle arthrodesis surgery (OR 1.4, CI 1.1-1.8, P = .0168), whereas differences that were statistically but not clinically significant were seen in cost and length of stay. In total ankle arthroplasty, no statistically significant associations were observed between drain use and the selected outcomes. Conclusion: This is the first national study on drain use in ankle surgery. We found a decrease in use over time. Drain use was associated with higher odds of blood transfusion in ankle arthrodesis patients. Although this negative effect may be mitigated by the rapidly decreasing use of drains, future studies are needed to discern drivers of drain use in this distinct surgical population. Level of Evidence: Level III, retrospective cohort study |
| first_indexed | 2024-04-13T01:59:59Z |
| format | Article |
| id | doaj.art-f8592148c49f414d96a9441ba0d59c81 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-04-13T01:59:59Z |
| publishDate | 2022-08-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-f8592148c49f414d96a9441ba0d59c812022-12-22T03:07:40ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142022-08-01710.1177/24730114221119735Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational StudyJeffrey Okewunmi BS0Jimmy J. Chan MD1Jashvant Poeran MD, PhD2Nicole Zubizarreta MPH3Madhu Mazumdar PhD4Ettore Vulcano MD5Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USADepartment of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USAInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USAInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USAInstitute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USADepartment of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USABackground: Closed wound drainage has been extensively studied in the hip and knee arthroplasty literature with equivocal results on its clinical benefits. Although also used in orthopaedic surgeries like ankle arthrodesis and ankle arthroplasty, large-scale data are currently lacking on utilization patterns and real-world effectiveness. We, therefore, aimed to address this research gap in this distinct surgical cohort using national claims data. Methods: Using the Premier Healthcare claims database from 2006 to 2016, ankle arthrodesis (n=10,085) and ankle arthroplasty (n=4,977) procedures were included. The main effect was drain use, defined by detailed billing descriptions. Outcomes included blood transfusion, 90-day readmission, and length and cost of hospitalization. Mixed-effects models measured associations between drain use and outcomes. Odds ratios (OR, or % change), 95% CIs, and P values are reported. Results: Overall, drains were used in 11% (n=1,074) and 15% (n=755) of ankle arthrodesis and ankle arthroplasty procedures, respectively. Drain use dramatically decreased over the years in both surgery types: from 14% to 6% and 24% to 7% between 2006 and 2016, for arthrodesis and ankle arthroplasty procedures, respectively. After adjustment for relevant covariates, drain use was associated with increased odds of blood transfusion in ankle arthrodesis surgery (OR 1.4, CI 1.1-1.8, P = .0168), whereas differences that were statistically but not clinically significant were seen in cost and length of stay. In total ankle arthroplasty, no statistically significant associations were observed between drain use and the selected outcomes. Conclusion: This is the first national study on drain use in ankle surgery. We found a decrease in use over time. Drain use was associated with higher odds of blood transfusion in ankle arthrodesis patients. Although this negative effect may be mitigated by the rapidly decreasing use of drains, future studies are needed to discern drivers of drain use in this distinct surgical population. Level of Evidence: Level III, retrospective cohort studyhttps://doi.org/10.1177/24730114221119735 |
| spellingShingle | Jeffrey Okewunmi BS Jimmy J. Chan MD Jashvant Poeran MD, PhD Nicole Zubizarreta MPH Madhu Mazumdar PhD Ettore Vulcano MD Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study Foot & Ankle Orthopaedics |
| title | Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study |
| title_full | Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study |
| title_fullStr | Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study |
| title_full_unstemmed | Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study |
| title_short | Association of Drain Use in Ankle Arthrodesis With Increased Blood Transfusion Risk: A National Observational Study |
| title_sort | association of drain use in ankle arthrodesis with increased blood transfusion risk a national observational study |
| url | https://doi.org/10.1177/24730114221119735 |
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