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Category: Ankle; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: There is a growing trend to perform surgical procedures at freestanding ambulatory surgical centers. No literature exists evaluating the rate of adverse events and overall safety of foot and ankle outpatient surgeries at a freestanding ambulatory surgery center (ASC). Methods: A retrospective review of all foot and ankle cases performed over a two year period at a single freestanding ASC. A total of 313 cases were performed. Adverse events are state-reported events that cause harm or lead to additional treatment. Using state-reported adverse events criteria and previous literature from hand and upper-extremity cases, we categorized our adverse events into seven categories: 1) infection requiring intravenous abx or return to the operating room, 2) postoperative transfer to a hospital, 3) wrong-site surgery, 4) retention of a foreign object, 5) postoperative symptomatic thromboembolism (DVT), 6) medication error, and 7) bleeding complications. Results: The overall rate of adverse events was 3.5% with 11 events identified over the two year period. There were a total of 10 infections and 1 symptomatic DVT. There were no cases that resulted in transfer to a hospital, hospital admission after discharge, medication error, bleeding complications, wrong-site procedures, or retained foreign bodies. Conclusion: Outpatient foot and ankle procedures are not without complications, but the overall rate of complications postoperatively is farly low (3.5%). Overall, foot and ankle surgeries can be performed safely in an outpatient setting at an ASC.

Category: Total Ankle Arthroplasty Introduction/Purpose: Although demand for total ankle arthroplasty (TAA) is increasing, access to high-volume TAA surgeons may vary in different geographic regions. Given that low-volume TAA surgeons have demonstrated higher revision rates compared to higher-volume surgeons, access to these high-volume centers is a matter of patient and public health interest. The recent public release of the Medicare Provider Utilization and Payment Public Use File (MPUP-PUF) now allows for identification of individual providers who perform specific procedures. This study analyzed surgeon prevalence, distribution and factors that correlate with higher or lower high-volume surgeon population in metropolitan areas. Methods: The MPUP-PUF was reviewed for the 2012-2015 calendar years and data were extracted for all physicians who performed a minimum of eleven TAA procedures among traditional Medicare patients. These physicians were grouped into major metropolitan areas (population of one million or more). Average reimbursement, number of high-volume TAA surgeons and number of total procedures were calculated per major metropolitan area. The presence of an American Orthopaedic Foot and Ankle Society (AOFAS) fellowship and mean geographic reimbursement were analyzed for correlation with number of high- volume TAA surgeons. Results: The MPUP-PUF for 2012 to 2015 included 58 unique surgeons who performed a minimum of 11 TAA procedures in any of those calendar years, with a combined total 2,281 Medicare TAA procedures. Of these surgeons, 81% practice within major metropolitan areas with population greater than one million. Distribution among major metropolitan areas is highly unequal and higher numbers of surgeons are present in cities with an AOFAS fellowship. Conclusion: Access to high-volume ankle replacement surgeons among the Medicare population is lacking in multiple major metropolitan areas in the United States due to the uneven distribution of these surgeons. This method of analysis allows for opportunities to target training programs as well as placement of physicians to ensure access to high-volume ankle arthroplasty surgeons.

Background: Inversion ankle injuries are extremely common, sometimes causing injury to the peroneus brevis tendon. If more than 50% of the tendon is injured, it oftentimes requires tenodesis to the adjacent peroneus longus tendon. Both Pulvertaft (PT) and side-to-side (SS) techniques have been used for joining the 2 tendons. The purpose of this study was to compare the strength and stiffness of these 2 techniques. Methods: Five matched pairs of cadaver ankle specimens were randomized to receive either an SS or PT tenodesis of the peroneus brevis to longus tendons. Following the tenodesis, the specimens were tested for failure load, displacement, energy absorbed at failure, and peak load. Stiffness was also calculated. Paired t tests were performed to detect differences between the 2 conditions. Results: There were no statistically significant differences between the SS and PT tenodesis for any of the metrics measured. For stiffness, the techniques were very similar (SS = 10.14 [4.35], PT = 12.85 [1.72]). Conclusion: There is no difference in failure load, displacement, energy absorbed at failure, peak load or stiffness between the PT and SS techniques for peroneal tenodesis. Level of Evidence: Level V, cadaver study.