Does Percutaneous Achilles Tenotomy Yield Comparable Short-Term Outcomes to Combined Open Achilles Tenotomy with Posterior Capsulotomy in Pediatric Patients with Clubfoot?

Abstract

Category: Hindfoot, Midfoot/Forefoot, Congenital Introduction/Purpose: As the most common musculoskeletal congenital anomaly, clubfoot (congenital talipes equinovarus) represents a commonly-encountered entity for pediatric orthopaedic and foot/ankle surgeons. As we have observed a shift towards more conservative, cost-conscious approaches to management, this study sought to compare short-term (30-day) perioperative and postoperative outcomes (complications and reoperations) in clubfoot patients who underwent either percutaneous Achilles tenotomy (PT) or combined open Achilles tenotomy with posterior capsulotomy (COTC). Methods: The National Surgical Quality Improvement Program (NSQIP) Pediatric Database was queried for all congenital clubfoot patients. Among those, patients who underwent percutaneous Achilles tenotomy (PT; CPT: 27606) or open Achilles tenotomy with posterior capsulotomy (COTC; CPT: 28262) were stratified into two cohorts. Cohorts were 1:1 propensity score-matched for gender, race, congenital clubfoot diagnosis, and ASA score. Demographics, peri- and 30-day postoperative data were collected for each group and compared using appropriate parametric tests. A p-value of 0.05 or lower indicated statistical significance. A binary stepwise multivariate regression model was used to assess the effects of age, gender, race, ASA score, congenital clubfoot, and surgery type on total complication and reoperation rates. Results: 690 patients were included (PT, n=345; COTC, n=345). PT patients were younger than COTC patients (1.58 vs. 4.26 years; p<0.001). However, gender and race distributions were comparable. PT patients incurred shorter operation-to-discharge intervals (0.24 vs. 1.1 days), total anesthesia (71.8 vs. 191.2 mins) and operative time (34.4 vs. 129.3 minutes) (all p<0.001). PT and COTC patients had comparable rates of postoperative complications (0.00 vs. 0.87%; p=0.082). Complications experienced by COTC patients included pneumonia (0.29%) and surgical site (0.29%), and urinary tract infections (0.29%). Both cohorts also had similar reoperation rates (0.58 vs. 1.45%; p=0.253). Multivariate regression analysis revealed that age, female sex, race, congenital clubfoot diagnosis, and type of surgery were not significantly associated with any increase in odds of incurring postoperative complications or reoperations. Conclusion: Patients who underwent PT were younger than those who underwent a COTC. In addition, COTCs were significantly longer and led to a greater length of stay than those who underwent PT. However, there was no significant difference in short-term post-operative complication and reoperation rates. Lastly, surgery type and operative time were not significant predictors for higher complication rates. Therefore, despite lengthier hospital stay and operative time for PT, COTC and PT had comparable and low short-term complication rates and appeared to be safe procedures for treatment of congenital clubfoot in pediatric patients.