Comparison of Early Postoperative Complications and Work Relative Value Units–Based Compensation After Primary Versus Revision Total Ankle Arthroplasty

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Abstract
Background: Total ankle arthroplasty (TAA) has been increasingly used to treat end-stage of ankle arthritis, leading to a corresponding rise in revision TAA (rTAA). Given the greater complexity of rTAA procedures, assessing whether early postoperative complications differ from primary TAA and whether current reimbursement models appropriately account for this complexity remains essential. Methods: Using the National Surgical Quality Improvement Program database from 2013 to 2022 and current procedural terminology codes, patients undergoing TAA or rTAA were identified. Demographics, comorbidities, and 30-day early postoperative complications were compared. Compensation metrics included surgical time, work relative value units (wRVU) per hour (wRVU/hr), and reimbursement rate ($/hr). Statistical analyses included chi square tests, unpaired t -tests, and analysis of covariance adjusting for age and postoperative complication rates. Results: A total of 2,418 TAA and 276 rTAA cases were identified. No statistically notable differences were noted in 30-day mortality, readmission, or revision surgery rates. Secondary complications were similar between groups, except for cardiac arrest, which was higher in the rTAA cohort (0.36% vs. 0%, P = 0.003), although the absolute incidence was low. rTAA was associated with more concomitant procedures (1.10 vs. 0.79, P = 0.001), longer surgical time (166.78 vs. 151.45 minutes, P = 0.003), and higher mean wRVU (20.98 vs. 17.04, P < 0.001), wRVU/hr (9.63 vs. 7.57, P < 0.001), and reimbursement rate/hr ($311.65/hr vs. $244.78/hr, P < 0.001). Conclusion: No notable differences were found in early postoperative outcomes between TAA and rTAA, indicating comparable early postoperative safety. rTAA procedures received appropriately higher compensation metrics, aligning with their greater surgical demands. These findings support the adequacy of current reimbursement models for rTAA in accounting for the increased complexity and surgical time associated with rTAA compared with primary TAA. Level of Evidence: Level III

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