Frailty is associated with increased length of stay, hospitalization costs and disposition to long-term care facilities after total ankle arthroplasty.

BACKGROUND The Hospital Frailty Risk Score (HFRS) is associated with adverse events after joint replacement, but outcomes following total ankle arthroplasty (TAA) remain unclear.

METHODS The National Readmissions Database (2017-2019) identified patients undergoing primary TAA, classified as frail or non-frail using HFRS. Thirty-day readmission rates, length of hospital stay (LOS), and hospitalization costs were compared between cohorts. Univariate analysis was used to compare 30-day complication rates, reoperation rates, and disposition designation.

RESULTS From a total of 6147 patients who underwent TAA, frail patients had longer LOS (2.4 vs. 1.6 days, p < 0.01), higher costs ($27,181 versus $24,777; p < 0.01), and more discharge to higher-level care (44.0 % versus 26.0 %; p < 0.01). Frailty was associated with longer LOS (IRR 1.36; p < 0.001) and increased costs (IRR 1.07; p < 0.001), but not associated with 30-day readmissions, complications, or reoperations.

CONCLUSION Frailty was associated with longer LOS, higher costs, and increased discharge to higher-level care in patients undergoing TAA.

LEVEL OF EVIDENCE IV.