Purpose <p>The risk of neuropraxic injury or other complications has not been described regarding complex/multiple arthroscopic interventions. This study aimed to examine the frequency of complications after ankle arthroscopy (AA) and identify whether a correlation exists between early postoperative complications and the number of concurrent procedures, possibly indicating procedural complexity. Additionally, we evaluated whether comorbidities, diagnoses, patient positioning, distractor use, tourniquet use/location, case duration, and number/types of portals confounded our data.</p> Methods <p>Retrospective chart review of all AAs performed at a single institution over 10&#xa0;years was performed utilizing CPT codes inclusive of arthroscopic ankle procedures. Operative records and chart reviews were undertaken to document complications.</p> Results <p>177 AAs were identified, 46 isolated AA (diagnostic arthroscopy and debridement only), and 131 multi-procedure AAs. 20/177 complications were identified (11.3%). 13 were nerve-related complications. All nerve-related complications resolved with observation except one patient, which required open neuroma excision. AA performed with additional procedures demonstrated an increased risk of complication (<i>p</i> = 0.039). 18/20 complications (90%) occurred in AA with additional procedures. In the AA with additional procedures group, tourniquet use correlated to complication risk (<i>p</i> = <i>0.03</i>). In the isolated AA group, use of both anterior and posterior portals correlated to complications (<i>p</i> = <i>0.01).</i> Gender, diabetes, smoking, and distractor use were not significantly correlated with complication risk in either group.</p> Conclusion <p>AA early postoperative complication risk increases with procedural complexity, with the most common complication being nerve-related injury, which may be related to technique, portal placement, and case length based on the literature. However, this study only found a correlation with the number of concurrent procedures. Operative time, tourniquet use, and distractor use were not correlated to early postoperative complication risk in this study.</p> Clinical relevance <p>The objective of this study was to identify if a correlation exists between early postoperative complications and the number of concurrent AA procedures, as well as evaluate risk factors for AA complications, to minimize complications in the future.</p> Level of evidence <p>Level III: Retrospective Cohort Study.</p>