Trends in Utilization of Charcot Reconstruction

Abstract

Category: Ankle; Diabetes Introduction/Purpose: Charcot arthropathy of the foot and ankle is a challenging complication of peripheral neuropathy with a 0.1% and 5.0% incidence in the diabetic population. The purpose of this study is to assess rates of foot or ankle reconstructions (fusions) for Charcot arthropathy, describe the associated patient demographics and hospital settings, and project the volume of Charcot reconstructions anticipated to be performed in 2030. Methods: The National Inpatient Sample database was queried from 2016-2019 using International Classification of Diseases (ICD) codes for foot or ankle fusion (midfoot, hindfoot, or ankle) and a diagnosis of Charcot arthropathy, ultimately identifying 1,343 patients undergoing surgical procedures. Patient information collected included age, sex, race, primary payer status, year of surgery, length of hospital stays, and median household income quartile. Hospital information included bed size, census region, teaching status, and ownership. Results: Between 2016-2019, there were approximately 1,343 patients treated surgically with midfoot, hindfoot, or ankle arthrodesis for Charcot arthropathy, and the number of cases increased by 12.11% annually. Between 2019-2030, there is projected to be a 121.41% increase in the frequency of Charcot reconstruction procedures from 383 to 848 total annual cases. Patients undergoing these procedures are predominantly white, male, and in their 50s. The most common payers were Medicare and private insurance. The mean hospital length of stay was 5.80 days. The procedures performed were predominantly large, urban teaching hospitals in the south with a private, non-profit ownership structure. Conclusion: Surgical reconstruction of Charcot arthropathy of the foot and ankle is steadily increasing in prevalence. These patients are predominantly white, male, and in their 50s. It is important for orthopaedic foot and ankle surgeons to be trained in the surgical management and reconstruction of Charcot arthropathy to meet the expected growing surgical need, which is projected to be 848 procedures annually by 2030.