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Kostev K, Gyasi RM, Konrad M, Yon DK, Jacob L. Hospital Length of Stay and Associated Factors in Patients with Osteoarthritis from Germany: A Cross-Sectional Study. J Clin Med 2024; 13:2628. [PMID: 38731157 PMCID: PMC11084543 DOI: 10.3390/jcm13092628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Objective: There is a scarcity of data on hospital length of stay (LOS) in the osteoarthritis population. Therefore, this study aimed to investigate hospital LOS and associated factors in patients with osteoarthritis from Germany. Methods: The present cross-sectional study included patients hospitalized for osteoarthritis in one of fourteen hospitals in Germany between 2018 and 2023 (hospital database; IQVIA). The study outcome was the duration of hospital stay in days. Study covariables included age, sex, hospital department, osteoarthritis type, co-diagnosis, and hospitalization-related procedure. Associations between covariables and hospital LOS were analyzed using hierarchical linear regression models. Results: There were 8770 patients included in the study (mean [standard deviation] age 68.7 [10.8] years; 60.2% women). The mean (standard deviation) hospital LOS was 8.5 (5.0) days. Factors positively and significantly associated with hospital LOS were older age, female sex, orthopedic surgery and other medical specialty departments (compared with other surgery departments), knee and other and unspecified osteoarthritis (compared with hip osteoarthritis), multiple co-diagnoses (e.g., acute posthemorrhagic anemia, other disorders of fluid, electrolyte, and acid-base balance, and disorders of purine and pyrimidine metabolism), and several hospitalization-related procedures (i.e., geriatric rehabilitation, hip arthroplasty, and knee arthroplasty). Conclusions: The mean hospital LOS was higher than eight days in this osteoarthritis population from Germany, with a spectrum of demographic, clinical, and hospitalization-related factors associated with this hospital LOS. In this context, interventions are needed to reduce the LOS of hospitalizations for osteoarthritis in Germany.
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Affiliation(s)
- Karel Kostev
- Epidemiology, IQVIA, Unterschweinstiege 2-14, 60549 Frankfurt am Main, Germany
- University Clinic, Philipps-University, 35037 Marburg, Germany
| | - Razak M. Gyasi
- African Population and Health Research Center, Nairobi 00100, Kenya
- National Centre for Naturopathic Medicine, Faculty of Health, Southern Cross University, Lismore, NSW 2480, Australia
| | - Marcel Konrad
- Department of Health and Social, FOM University of Applied Sciences for Economics and Management, 45127 Essen, Germany
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea
- Department of Regulatory Science, Kyung Hee University, Seoul 02447, Republic of Korea
- Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul 02447, Republic of Korea
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, 42, 08830 Sant Boi de Llobregat, Spain
- AP-HP, Université Paris Cité, Lariboisière-Fernand Widal Hospital, Department of Physical Medicine and Rehabilitation, 75010 Paris, France
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases (EpiAgeing), 75010 Paris, France
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Ong CB, Buchan GBJ, Hecht Ii CJ, Lawrie CM, DeCook CA, Sculco PK, Kamath AF. Robotic-assisted total hip arthroplasty utilizing a fluoroscopy-guided system resulted in improved intra-operative efficiency relative to a computerized tomography-based platform. J Robot Surg 2023; 17:2841-2847. [PMID: 37770721 DOI: 10.1007/s11701-023-01723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/17/2023] [Indexed: 09/30/2023]
Abstract
Robotic-assisted total hip arthroplasty (THA) using a computerized-tomography (CT) based workflow increases surgical time relative to traditional manual technique. The purpose of this investigation was to compare the intra-operative efficiencies of two robotic THA systems: a fluoroscopy-based platform (FL-RTHA) and a contemporary, CT-based (CT-RTHA) platform. A review of 107 consecutive FL-RTHA and 159 CT-RTHA primary, direct anterior approach (DAA) THA procedures was conducted. All cases were performed by one of two surgeons operating at the same institution, for a pre-operative diagnosis of osteoarthritis, avascular necrosis, or rheumatoid arthritis. Primary outcome variables included averages and consistencies (variances) for surgical times and operating room (OR) times. A secondary outcome was to quantify the duration of robot-active phases in the FL-RTHA workflow. The FL-RTHA cohort experienced shorter surgical times (38.71 min ± 7.00 vs. 75.33 min ± 11.38; p < 0.001) and OR times (101.35 min ± 12.22 vs. 156.74 min ± 17.79; p < 0.001) compared to the CT-RTHA cohort. Surgical times and OR times were both more consistent in the FL-RTHA cohort compared to the CT-RTHA cohort (p < 0.001). Patients who underwent DAA THA with the assistance of a fluoroscopy-based robotic system experienced shorter and more consistent surgical times and OR times compared to patients who underwent similar DAA THA procedures with a contemporary, CT-based robotic platform.
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Affiliation(s)
- Christian B Ong
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Graham B J Buchan
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Christian J Hecht Ii
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Charles M Lawrie
- Department of Orthopaedic Surgery, Baptist Health South Florida, 8940 N Kendall Dr Suite 601E, Miami, FL, 33176, USA
| | - Charles A DeCook
- Arthritis and Total Joint Specialists, 2000 Howard Farm Drive, Suite 200, Cumming, GA, 30041, USA
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 541 E 71St St 6th Floor, New York, NY, 10021, USA
| | - Atul F Kamath
- Department of Orthopaedic Surgery, Orthopaedic and Rheumatologic Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Langenberger B, Steinbeck V, Schöner L, Busse R, Pross C, Kuklinski D. Exploring treatment effect heterogeneity of a PROMs alert intervention in knee and hip arthroplasty patients: A causal forest application. Comput Biol Med 2023; 163:107118. [PMID: 37392619 DOI: 10.1016/j.compbiomed.2023.107118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
Patient reported outcome measures (PROMs) experience an uptake in use for hip (HA) and knee arthroplasty (KA) patients. As they may be used for patient monitoring interventions, it remains unclear whether their use in HA/KA patients is effective, and which patient groups benefit the most. Nonetheless, knowledge about treatment effect heterogeneity is crucial for decision makers to target interventions towards specific subgroups that benefit to a greater extend. Therefore, we evaluate the treatment effect heterogeneity of a remote PROM monitoring intervention that includes ∼8000 HA/KA patients from a randomized controlled trial conducted in nine German hospitals. The study setting gave us the unique opportunity to apply a causal forest, a recently developed machine learning method, to explore treatment effect heterogeneity of the intervention. We found that among both HA and KA patients, the intervention was especially effective for patients that were female, >65 years of age, had a blood pressure disease, were not working, reported no backpain and were adherent. When transferring the study design into standard care, policy makers should make use of the knowledge obtained in this study and allocate the treatment towards subgroups for which the treatment is especially effective.
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Metcalf RW, Rowe T, Tersteeg M, Dombrowski ME, Odum S, Otero JE. The Influence of Patient Sex on Outcomes Following One-Stage and Two-Stage Revision for Periprosthetic Joint Infection in Total Joint Arthroplasty. Antibiotics (Basel) 2023; 12:1392. [PMID: 37760688 PMCID: PMC10525713 DOI: 10.3390/antibiotics12091392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
Although females have a higher rate of primary total joint arthroplasty (TJA), males have a higher rate of revision. The literature lacks studies examining the relationship between sex and outcomes following single and two-stage exchange for periprosthetic joint infection (PJI). The purpose of this study was to examine if differences exist in outcomes following revision for chronic PJI between sexes. A retrospective review was performed on all patients with an MSIS confirmed PJI who underwent a single or two-stage exchange at our institution from January 2010 to January 2021. Patient demographics, comorbidity characteristics, and outcomes were collected and compared between males and females. The primary outcome variable was disease-free survival at 1 year following definitive revision. Multivariable logistic regression analysis was performed to determine risk factors for failure. Of the 470 patients meeting final eligibility criteria, 250 were male and 226 were female (2 males and 4 females had a joint infection of either the contralateral side or a different joint and were treated as separate records). Of the patients in the cohort, 80% of the males (200/250) and 80% of the females (181/226) were found to be disease-free at 1-year follow-up (p > 0.99). Multivariable logistic regression analysis showed that nicotine use and diabetes, but not sex, were significant predictors of failure. Our study did not find a relationship between sex and outcome of revision for PJI. Further research is required to determine whether differences exist between males and females in the expression of PJI and outcomes following treatment.
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Affiliation(s)
- Rory W. Metcalf
- OrthoCarolina Research Institute, Charlotte, NC 28207, USA; (R.W.M.)
| | - Taylor Rowe
- OrthoCarolina Research Institute, Charlotte, NC 28207, USA; (R.W.M.)
| | - Megan Tersteeg
- Saint Louis University School of Medicine, St. Louis, MO 63104, USA
| | | | - Susan Odum
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
| | - Jesse E. Otero
- OrthoCarolina Hip & Knee Center, Atrium Health Musculoskeletal Institute, Charlotte, NC 28207, USA
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Koettnitz J, Migliorini F, Peterlein CD, Götze C. Same-gender differences in perioperative complications and transfusion management for lower limb arthroplasty. BMC Musculoskelet Disord 2023; 24:653. [PMID: 37587440 PMCID: PMC10429068 DOI: 10.1186/s12891-023-06788-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/08/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Total hip (THA) and knee arthroplasty (TKA) are surgical interventions for patients with primary and posttraumatic osteoarthritis. The present clinical investigation compared gender differences in THA and TKA. METHODS Data from 419 patients following primary THA and TKA were collected. The occurrence of systemic and surgery-related complications, the units of blood transfused, and the change in Hb were investigated. Hb was collected preoperatively and at 1, 2, 4 and 7 days postoperatively. Statistical analysis was performed using the software IBM SPSS 28. RESULTS There was no significant difference in surgery-related and general complications in men between THA and TKA. A significant difference between THA and TKA in systemic complications in women was observed. No significant difference between THA and TKA in related to surgery-related complications was evidenced. In men, no difference in Hb progression was observed. In women, a significant Hb drop was evidenced (p = 0.03). The rate of blood transfusion units in women was significantly greater in TKA than in THA (p = 0.001). No statistically significant difference was observed in men in the rate of transfusion between THA and TKA. CONCLUSION Perioperative care should be organized differently for women and men. Furthermore, a differentiation between the procedures for each sex could prevent the occurrence of perioperative complicated courses.
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Affiliation(s)
- Julian Koettnitz
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, Bad Oeynhausen, 32545 Germany
| | - Filippo Migliorini
- Department of Orthopaedics and Trauma Surgery, University Clinic Aachen, RWTH Aachen University Clinic, 52064 Aachen, Germany
| | - Christian D. Peterlein
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, Bad Oeynhausen, 32545 Germany
| | - Christian Götze
- Department of General Orthopaedics, Auguste-Viktoria-Clinic Bad Oeynhausen, University Hospital of Ruhr-University-Bochum, Am Kokturkanal, Bad Oeynhausen, 32545 Germany
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Capin JJ, Minick K, Stevens-Lapsley JE, Snow G, Woodfield D, Dibblee P, Brennan G, Hunter SJ. Variation in Outcomes and Number of Visits Following Care Guideline Implementation: Part 2 of an Analysis of 12 355 Patients After Total Knee Arthroplasty. J Orthop Sports Phys Ther 2023; 53:151-158. [PMID: 36503269 PMCID: PMC10166070 DOI: 10.2519/jospt.2022.11370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE: To describe the variation in outcomes and number of visits before and after implementing a care guideline for total knee arthroplasty (TKA) rehabilitation. DESIGN: Nonrandomized intervention study. METHODS: We compared 2558 patients with TKA who received care that was not standardized (non-care guideline [NCG] group) to 9797 patients with TKA who received care according to the care guideline (CG). We fit 2 Bayesian hierarchical linear regression models using the Knee Outcome Survey - Activities of Daily Living (KOS-ADL) change score and number of physical therapy (PT) visits as the response variables, controlling for relevant predictor variables. We also compared the ratio of the standard deviations of the KOS-ADL change scores and the number of PT visits within and between clinics. RESULTS: The overall estimated mean improvement in KOS-ADL change score was 23.0 points (95% confidence interval [CI]: 20.3, 25.7) in the NCG group and 28.7 points (95% CI: 27.5, 29.7) in the CG group; the mean difference was 5.6 (2.7-8.6). Mean KOS-ADL change scores were higher in the CG group than the NCG group in every clinic, although only 8 clinics improved significantly. The number of PT visits did not change meaningfully (NCG: mean, 10.7 [95% CI: 9.9, 11.5]; CG: mean, 10.5 [95% CI: 9.9, 10.9]). Variation in KOS-ADL change score decreased by 4% within clinics (CG-NCG ratio: 0.96 [95% CI: 0.93, 0.99]) and 63% between clinics (CG-NCG ratio: 0.37 [95% CI: 0.21, 0.62]). Variation in number of visits decreased by 7% within clinics (CG-NCG ratio: 0.93 [95% CI: 0.90, 0.96]) and 19% between clinics (CG-NCG ratio: 0.81 [95% CI: 0.39, 1.49]). CONCLUSION: Implementing a care guideline for TKA rehabilitation may improve outcomes and reduce unwarranted variation in practice within clinics and especially between clinics within a large health care system. J Orthop Sports Phys Ther 2023;53(3):151-158. Epub: 12 December 2022. doi:10.2519/jospt.2022.11370.
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Affiliation(s)
- Jacob J. Capin
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
- Clinical and Translational Institute, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kate Minick
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT
| | - Jennifer E. Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA
- Eastern Colorado VA Geriatric Research Education and Clinical Center (GRECC), Aurora, CO, USA
| | - Greg Snow
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT
| | - Devyn Woodfield
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT
| | - Pam Dibblee
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT
| | - Gerard Brennan
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT
| | - Stephen J. Hunter
- Rehabilitation Services, Intermountain Healthcare, Salt Lake City, UT
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Maloy GC, Kammien AJ, Rubin LE, Grauer JN. Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study. J Arthroplasty 2023; 38:525-529. [PMID: 36272511 DOI: 10.1016/j.arth.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/04/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Many previous studies of total hip arthroplasty (THA) have focused on adverse events occurring within 30 days of surgery. Studies examining 90-day postoperative adverse events have typically not focused on the timing of adverse events within that period. The current study evaluated the rate and timing of adverse events within 90 days of THA. METHODS Adult THA patients between 2010 and 2020 Q3 were identified from a large administrative dataset. Rates and timing of 90-day adverse events were determined. The median, interquartile range, and middle 80% were calculated based on the time of diagnosis for each adverse event. These were also dichotomized as occurring before or after 30 days and predictive factors for later adverse events were determined. RESULTS Overall, 81,158 adverse events were noted, of which 56,500 (69.0%) were diagnosed within 30 days of surgery and 25,355 (31.0%) were diagnosed 31-90 days after surgery. The proportion of adverse events occurring 31-90 days after surgery ranged from 6% (transfusion) to 45% (wound dehiscence). Patients experiencing a later adverse event were more likely to be women and to have higher Elixhauser Comorbidity Index (ECI) scores. CONCLUSION Almost one-third of adverse events following THA were diagnosed between postoperative days 31 and 90, highlighting the importance of looking beyond 30 days when estimating patients' risk of postoperative adverse events. These data may inform future research, patient counseling, and prevention strategies.
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Affiliation(s)
- Gwyneth C Maloy
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Alexander J Kammien
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Lee E Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan N Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
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Liu EX, Kuhataparuks P, Liow MHL, Pang HN, Tay DKJ, Chia SL, Lo NN, Yeo SJ, Chen JY. Clinical Frailty Scale is a better predictor for adverse post-operative complications and functional outcomes than Modified Frailty Index and Charlson Comorbidity Index after total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07316-z. [PMID: 36795126 DOI: 10.1007/s00167-023-07316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Studies have demonstrated correlations between frailty and comorbidity scores with adverse outcomes in total knee replacement (TKR). However, there is a lack of consensus on the most suitable pre-operative assessment tool. This study aims to compare Clinical Frailty Scale (CFS), Modified Frailty Index (MFI), and Charlson Comorbidity Index (CCI) in predicting adverse post-operative complications and functional outcomes following a unilateral TKR. METHODS In total, 811 unilateral TKR patients from a tertiary hospital were identified. Pre-operative variables were age, gender, body mass index (BMI), American Society of Anesthesiologists (ASA) class, CFS, MFI, and CCI. Binary logistic regression analysis was performed to ascertain odd ratios of pre-operative variables on adverse post-operative complications (length of stay < LOS >, complications, ICU/HD admission, discharge location, 30-day readmission, 2-year reoperation). Multiple linear regression analyses were used to estimate the standardized effects of pre-operative variables on the Knee Society Functional Score (KSFS), Knee Society Knee Score (KSKS), Oxford Knee Score (OKS), and 36-Item Short Form Survey (SF-36). RESULTS CFS is a strong predictor for LOS (OR 1.876, p < 0.001), complications (OR 1.83-4.97, p < 0.05), discharge location (OR 1.84, p < 0.001), and 2-year reoperation rate (OR 1.98, p < .001). ASA and MFI were predictors for ICU/HD admission (OR:4.04, p = 0.002; OR 1.58, p = 0.022, respectively). None of the scores was predictive for 30-day readmission. A higher CFS was associated with a worse outcome for 6-month KSS, 2-year KSS, 6-month OKS, 2-year OKS, and 6-month SF-36. CONCLUSION CFS is a superior predictor for post-operative complications and functional outcomes than MFI and CCI in unilateral TKR patients. This suggests the importance of assessing pre-operative functional status when planning for TKR. LEVEL OF EVIDENCE Diagnostic, II.
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Affiliation(s)
- Eric Xuan Liu
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore.
| | - Punn Kuhataparuks
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Ming-Han Lincoln Liow
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Hee-Nee Pang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Darren Keng Jin Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Shi-Lu Chia
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Ngai-Nung Lo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Seng-Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
| | - Jerry Yongqiang Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 college road, Academia level 4, Singapore, 169856, Singapore
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9
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Zhou Z, Cai G, Yuan S, Song L, Qian P, Wang X, Ning X, Wang J, Jiang W. Perioperative safety assessment of patients undergoing unilateral or bilateral hip replacements. Front Surg 2023; 10:944311. [PMID: 36778646 PMCID: PMC9910789 DOI: 10.3389/fsurg.2023.944311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction Due to the aging of the world population and the increase of obesity rate, it is expected that the number of joint replacement surgery will continue to increase in the next few years. This study evaluated the safety differences between unilateral and bilateral hip replacement surgeries. Methods The data for patients who underwent hip arthroplasty in 2021 and 2022 were examined. The data set included 68 patients who were grouped according to the type of hip replacement needed, sex, age, and body mass index. Total blood loss and operative time were the safety-related indicators used to compare the groups. Results Regardless of whether the unilateral replacement group was compared with the overall bilateral replacement group or separately with the staged and simultaneous bilateral replacement groups, simultaneous bilateral replacement surgeries were equally safe as the other types of hip replacements. The total blood loss and operative time for the simultaneous bilateral replacement group were not significantly different from those in the unilateral and staged bilateral replacement groups. For overweight patients, the operative time for simultaneous bilateral replacements was significantly shorter than that for unilateral replacements. Conclusions These findings suggest that for patients requiring bilateral hip replacements, the blood loss risk for patients undergoing simultaneous bilateral hip replacements was similar to that for patients undergoing either unilateral or staged bilateral hip replacements. Thus, simultaneous bilateral total hip replacement (THR) are safe and should be considered for candidate patients.
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Affiliation(s)
- Zhenzhong Zhou
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Gaorui Cai
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Shanyou Yuan
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Lixia Song
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Ping Qian
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Xueming Wang
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Xianjia Ning
- Center of Clinical Epidemiology, The Third People's Hospital of Shenzhen, Guangdong, China
| | - Jinghua Wang
- Center of Clinical Epidemiology, The Third People's Hospital of Shenzhen, Guangdong, China,Correspondence: Wenxue Jiang ; Jinghua Wang
| | - Wenxue Jiang
- Department of Orthopedics, The Third People's Hospital of Shenzhen, Guangdong, China,Correspondence: Wenxue Jiang ; Jinghua Wang
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10
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Higgins E, Tai DBG, Lahr B, Suh G, Berbari E, Perry K, Abdel M, Tande A. Sex-specific analysis of clinical features and outcomes in staphylococcal periprosthetic joint infections managed with two-stage exchange arthroplasty. J Bone Jt Infect 2023; 8:125-131. [PMID: 37123501 PMCID: PMC10134758 DOI: 10.5194/jbji-8-125-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/10/2023] [Indexed: 05/02/2023] Open
Abstract
Background: Differences in susceptibility and response to infection between males and females are well established. Despite this, sex-specific analyses are under-reported in the medical literature, and there is a paucity of literature looking at differences between male and female patients with periprosthetic joint infection (PJI). Whether there are sex-specific differences in presentation, treatment tolerability, and outcomes in PJI has not been widely evaluated. Methods: We undertook a retrospective case-matched analysis of patients with staphylococcal PJI managed with two-stage exchange arthroplasty. To control for differences other than sex which may influence outcome or presentation, males and females were matched for age group, causative organism category (coagulase-negative staphylococci vs. Staphylococcus aureus), and joint involved (hip vs. knee). Results: We identified 156 patients in 78 pairs of males and females who were successfully matched. There were no significant baseline differences by sex, except for greater use of chronic immunosuppression among females (16.4 % vs. 4.1 %; p = 0.012 ). We did not detect any statistically significant differences in outcomes between the two groups. Among the 156 matched patients, 16 recurrent infections occurred during a median follow-up time of 2.9 (IQR 1.5-5.3) years. The 3-year cumulative incidence of relapse was 16.1 % for females, compared with 8.8 % for males ( p = 0.434 ). Conclusions: Success rates for PJI treated with two-stage exchange arthroplasty are high, consistent with previously reported literature. This retrospective case-matched study did not detect a significant difference in outcome between males and females with staphylococcal PJI who underwent two-stage exchange arthroplasty.
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Affiliation(s)
- Eibhlin Higgins
- Division of Public Health, Infectious Diseases and
Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Don Bambino Geno Tai
- Division of Public Health, Infectious Diseases and
Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Infectious Diseases and International Medicine,
University of Minnesota, Minneapolis, Minnesota, USA
| | - Brian Lahr
- Department of Quantitative Health Sciences, Mayo Clinic,
Rochester, Minnesota, USA
| | - Gina A. Suh
- Division of Public Health, Infectious Diseases and
Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Elie F. Berbari
- Division of Public Health, Infectious Diseases and
Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin I. Perry
- Department of Orthopedic Surgery, Mayo Clinic, Rochester,
Minnesota, USA
| | - Matthew P. Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester,
Minnesota, USA
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases and
Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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11
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Sinclair ST, Klika AK, Jin Y, Higuera CA, Piuzzi NS. The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA. J Bone Joint Surg Am 2022; 104:2016-2025. [PMID: 36047698 DOI: 10.2106/jbjs.21.01339] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies involving total knee arthroplasty (TKA) have focused on patient-related factors as drivers of outcomes. Although some studies have investigated surgeon and/or surgery-level factors (i.e., approach, volume), the measure of variance in postoperative outcomes across surgeons following TKA has not been determined. The aim of the current study was to evaluate the relationship between the surgeon and 1-year patient-reported outcome measures, the length of stay, the discharge disposition, and 90-day readmission after TKA, as well as the differences in these variables among surgeons. METHODS Data were prospectively collected for 5,429 patients who underwent TKA at a large health-care system with 36 surgeons between 2016 and 2018. Likelihood ratio tests were performed to investigate the relationship between surgeon and the 1-year Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain subscale, KOOS-Physical Function Shortform (KOOS-PS), KOOS for Joint Replacement (KOOS-JR), patient acceptable symptom state (PASS), length of stay, discharge disposition, and 90-day readmission. The minimal clinically important difference (MCID) was used to assess meaningful outcomes. Variable importance was determined by the Akaike information criterion (AIC) increase, using ordinal and binary-response mixed-effect models. RESULTS There was a significant association between surgeon and KOOS-Pain (p < 0.001), KOOS-PS (p = 0.001), KOOS-JR (p < 0.001), PASS (p = 0.024), length of stay (p < 0.001), discharge disposition (p < 0.001), and 90-day readmission (p < 0.001). When modeling 1-year KOOS-Pain (AIC increase, 15.6), KOOS-PS (AIC increase, 6.8), KOOS-JR (AIC increase, 13.5), PASS (AIC increase, 1.9), length of stay, and discharge disposition, the surgeon variable contributed more to the 1-year outcome than some patient-level factors (e.g., body mass index, Charlson Comorbidity Index). The difference between the highest and lowest median probabilities of attaining the same value for the KOOS-Pain (11.2%), KOOS-PS (9.4%), KOOS-JR (11.8%), PASS (5.9%), length of stay (46.6%), discharge disposition (22.8%), and readmission (13.1%) indicated surgeon-level variability. CONCLUSIONS Surgeon-related factors may be stronger contributors to the 1-year patient-reported outcome measures and length of stay than patient characteristics emphasized in the literature. Current findings have suggested variability in patient-reported outcome measures, length of stay, discharge location, and 90-day readmission among surgeons. Surgeon variability should be considered when model-fitting in the setting of TKA. LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- SaTia T Sinclair
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.,Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Carlos A Higuera
- Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.,Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio
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12
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Ishii Y, Noguchi H, Sato J, Takahashi I, Ishii H, Ishii R, Ishii K, Toyabe SI. Comparison of Operative Times in Primary Bilateral Total Knee Arthroplasty Performed by a Single Surgeon. J Clin Med 2022; 11:jcm11164867. [PMID: 36013109 PMCID: PMC9410018 DOI: 10.3390/jcm11164867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose: Prolonged operative time (OT) is associated with adverse complications after total knee arthroplasty (TKA). The purpose of this study was to determine whether preoperative factors, such as sex, age, body mass index, body weight (BW), body height, American Society of Anesthesiologists grade, tibiofemoral angle, hospital for special surgery scores, surgical side, surgical order, and calendar year of surgery, affect OT. Methods: One hundred and nineteen patients (238 knees) with osteoarthritis who underwent staged bilateral primary TKA performed by a single surgeon were evaluated. The medical records of 15 males and 104 females were retrospectively reviewed. All variables were expressed as median (interquartile range). Results: The OT for all TKAs was 57 min (51, 65). The OT on the left side (59 min (52−67)) was longer than that on the right side (55 min (50−62)) (p = 0.015). Multiple regression analysis revealed that longer OT was related to BW (β = 0.488, p < 0.001), calendar year of surgery (β = −0.218, p< 0.001), and operative side (β = −0.151, p = 0.007). The Jonckheere−Terpstra test showed a trend toward decreasing OT with calendar year on the left side (p = 0.037) (surgeon’s non-dominant side), but not on the right (p = 0.795). Body height, BW, and body mass index showed weak correlations (r = 0.212, p = 0.001; r = 0.352, p < 0.001; r = 0.290, p < 0.001, respectively) with OT. Conclusion: Patients with a large physique, and especially obesity, with an affected knee on the surgeon’s non-dominant side may require a longer OT; OT decreased over time.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
- Correspondence: ; Tel.:+81-48-555-3519; Fax: +81-48-555-3520
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Ikuko Takahashi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama 361-0037, Japan
| | - Hana Ishii
- School of Plastic Surgery, Kanazawa Medical University, 1-1 Daigaku Uchinada, Ishikawa 920-0253, Japan
| | - Ryo Ishii
- School of Orthopaedic Surgery, Shinshu University Hospital, 3-1-1 Asahi Matsumoto, Nagano 390-8621, Japan
| | - Kei Ishii
- Iwate Prefectural Ninohe Hospital, 38 Horino, Ninohe, Iwate 028-6193, Japan
| | - Shin-ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata 951-8520, Japan
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13
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Williams CL, Pujalte G, Li Z, Vomer RP, Nishi M, Kieneker L, Ortiguera CJ. Which Factors Predict 30-Day Readmission After Total Hip and Knee Replacement Surgery? Cureus 2022; 14:e23093. [PMID: 35464578 PMCID: PMC9001084 DOI: 10.7759/cureus.23093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background The Centers for Medicare and Medicaid Services enacted the Hospital Readmissions Reduction Program to impose penalties for diagnoses with high readmission rates. Despite several elective orthopedic procedures being included in this program, readmission rates have not declined, and associated costs have reached critical levels for total knee and total hip arthroplasty. Readmissions drastically impact patient outcomes. There are many known contributors to patient readmission rates, including infection, pain, and hematomas. However, evidence is inconclusive regarding other aspects, such as demographics, insurance, and discharge disposition. The purpose of this manuscript is to 1) measure hospital readmission rates for total knee and total hip arthroplasty, 2) evaluate the causes of readmissions, and 3) provide a predictive profile of risk factors associated with hospital readmissions. Methods Patients who underwent total knee or total hip arthroplasty were identified through a retrospective database review. An electronic chart review extracted data concerning patient demographics, comorbidities, surgical information, 30-day outcomes, and reasons for 30-day readmissions. Continuous and categorical variables were assessed with the Wilcoxon rank-sum test and the Chi-square test, respectively. Results A total of 6,065 patients were included, with 269 (4.4%) having at least one surgery-related 30-day readmission. No differences in readmission were noted with age, sex, or ethnicity; however, differences were found in weight and body mass index. Statistically significant comorbidities were heart failure, chronic obstructive pulmonary disease, dialysis, and alcohol use or abuse. Conclusion Our research indicated that surgery type, length of stay, and heart failure most significantly impacted 30-day readmission rates. By assessing readmission rates, we can take steps to optimize care for non-elective surgeries that will improve patient outcomes and cost-effectiveness.
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14
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Edwards NM, Varnum C, Nelissen RGHH, Overgaard S, Pedersen AB. The association between socioeconomic status and the 30- and 90-day risk of infection after total hip arthroplasty : a registry-based cohort study of 103,901 patients with osteoarthritis. Bone Joint J 2022; 104-B:221-226. [PMID: 35094583 DOI: 10.1302/0301-620x.104b2.bjj-2021-1030.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS The aim of this study was to examine whether socioeconomic status (SES) is associated with a higher risk of infections following total hip arthroplasty (THA) at 30 and 90 days. METHODS We obtained individual-based information on SES markers (cohabitation, education, income, and savings) on 103,901 THA patients from Danish health registries between 1 January 1995 and 31 December 2017. The primary outcome measure was any hospital-treated infection (i.e. all infections). The secondary outcomes were further specified to specific hospital-treated infections (pneumonia, urinary tract infection, and periprosthetic joint infection). The primary timepoint was within 90 days. In addition, the outcomes were further evaluated within 30 days. We calculated the cumulative incidence, and used the pseudo-observation method and generalized linear regression to estimate adjusted risk ratios (RRs) with 95% confidence intervals (CIs) for each marker. RESULTS The cumulative incidence of any infection at 90 days was highest in patients who lived alone (1.5% (95% CI 1.3 to 1.6)) versus cohabitant (0.7% (95% CI 0.7 to 0.8)), had the lowest educational achievement (1.1% (95% CI 1.0 to 1.2)) versus highest (0.7% (95% CI 0.5 to 0.8)), had the lowest income (1.6% (95% CI 1.5 to 1.70)) versus highest (0.4% (95% CI 0.3 to 0.5)), or had lowest savings (1.3% (95% CI 1.2 to 1.4)) versus highest (0.7% (95% CI 0.6 to 0.8)). Within 90 days, the RRs for any infection were 1.3 (95% CI 1.2 to 1.4) for patients living alone versus cohabiting, 1.2 (95% CI 1.0 to 1.3) for low education achievement versus high, 1.7 (95% CI 1.4 to 2.1) for low income versus high income, and 1.5 (95% CI 1.4 to 1.8) for low savings versus high savings. The same trends were also seen for any infections within the first 30 days. CONCLUSION Our study provides evidence that socioeconomic inequality adversely influences the risk of infection after THA, thus contributing to healthcare disparities and inequalities. We found that living alone, low educational achievement, low income, or low savings were associated with higher risks of infections within the first 30 and 90 days after THA. Therefore, the development of targeted intervention strategies with the aim of increasing awareness of patients identified as being at greatest risk is needed to mitigate the impact of SES on the risk of infections following THA. Cite this article: Bone Joint J 2022;104-B(2):221-226.
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Affiliation(s)
- Nina M Edwards
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery and Traumatology, Odense Universitetshospital, Odense, Denmark.,Danish Hip Arthroplasty Register, Copenhagen, Denmark
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leids Universitair Medisch Centrum, Leiden, Netherlands
| | - Søren Overgaard
- Danish Hip Arthroplasty Register, Copenhagen, Denmark.,Copenhagen University Hospital, Bispebjerg Department of Orthopaedic Surgery and Traumatology, Frederiksberg Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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15
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Rohe S, Röhner E, Windisch C, Matziolis G, Brodt S, Böhle S. Sex Differences in Serum C-Reactive Protein Course after Total Hip Arthroplasty. Clin Orthop Surg 2022; 14:48-55. [PMID: 35251541 PMCID: PMC8858890 DOI: 10.4055/cios21110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/26/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background Gender-specific medicine has become an important part in investigating the course of various diseases. C-reactive protein (CRP) is used as an inflammatory marker for detecting inflammations and even infections after total hip arthroplasty (THA). The general course of CRP after THA is well known, but there is controversy about its association with sex. Therefore, we aimed to investigate if there is an influence of sex on the CRP after THA in the first 10 days after operation in a complication-free course in male and female patients and to re-evaluate the specific postoperative CRP course with its maximum on the second to third postoperative days. Methods We retrospectively reviewed patients who had been treated with THA due to primary osteoarthritis through the same approach using an equal model of a cementless stem and a cup and complication-free between 2013 and 2016. Patients with active inflammation, rheumatoid arthritis, secondary arthrosis, active cancer disease, and documented postoperative complications were not included. The CRP values before THA and up to 10 days after THA were recorded and tested for sex discrepancy. Factor analyses were performed, and CRP values were adjusted for confounders (age, operation time, diabetes mellitus, and body mass index [BMI]). Results A total of 1,255 patients (728 women and 527 men) were finally analyzed. Men were younger and had a longer operation time and a higher BMI compared to women. The prevalence of overweight was higher in men, while obesity (BMI > 40 kg/m2), diabetes mellitus, renal failure, and American Society of Anaesthesiologists status showed no significant difference between men and women. Men had significantly higher CRP values than women between the 2nd and the 7th postoperative days, with the largest difference on the 4th postoperative day (men, 130.48 mg/L; women, 87.26 mg/L; p = 0.018). Conclusions Based on the results of more precise sex-specific evaluation of the postoperative CRP course after THA, the present study showed for the first time that there was a gender discrepancy in the CRP course after complication-free THA in the first 7 postoperative days. Furthermore, this study confirmed the postoperative CRP course with its maximum on the third postoperative day.
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Affiliation(s)
- Sebastian Rohe
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Eric Röhner
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | | | - Georg Matziolis
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Steffen Brodt
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
| | - Sabrina Böhle
- Orthopaedic Professorship of the University Hospital Jena, Orthopedic Department of the Waldkliniken Eisenberg, Eisenberg, Germany
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16
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Zhai K, Orr M, Grits D, Emara AK, Rothfusz CA, Piuzzi NS. Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients. J Knee Surg 2021; 36:575-583. [PMID: 34921379 DOI: 10.1055/s-0041-1740386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite its rarity, the risk of mortality following primary elective total knee arthroplasty (TKA) is a critical component of surgical decision-making and patient counseling. The purpose of our study was to (1) determine the overall 30-day mortality rate for unilateral primary elective TKA patients, (2) determine the 30-day mortality rates when stratified by age, comorbidities, and preoperative diagnosis, and (3) identify the distribution of (i) patient demographics, (ii) baseline comorbidities, and (iii) preoperative diagnoses between mortality and mortality-free cohorts. A total of 326,157 patients underwent primary elective TKA (2011-2018) were identified through retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into 30-day mortality (n = 320) and mortality-free (n = 325,837) cohorts. Patient demographics, preoperative comorbidities, and preoperative diagnoses were compared. Age group, American Society of Anesthesiology (ASA) score, and modified Charlson Comorbidity Index (CCI) scores were normalized per 1000 and stratified by preoperative diagnosis. The overall mortality rate was 0.098%. Older age (p < 0.001) and male gender (p < 0.001) were associated with increased mortality. There was no association between mortality and race (p = 0.346) or body mass index (BMI) class (p = 0.722). All reported comorbidities except smoking status were significantly greater in the mortality cohort (p < 0.05). For ASA scores of I, II, III, and IV, the number of deaths per 1,000 were 0.16, 0.47, 1.4, and 4.4, respectively. For CCI scores of 0, 1, 2, 3, 4, and 6, mortality rates per 1,000 were 0.76, 2.1, 7.0, 11, 29, and 7.6, respectively. Mortality rates for a preoperative diagnosis of osteoarthritis (OA) versus non-OA were, respectively, 0.096% and 0.19% (p < 0.001). Increased age, male gender, increased comorbidity burden, and non-OA preoperative diagnoses are associated with higher rates of 30-day postoperative mortality. There were no significant associations between BMI or race and 30-day mortality. These findings aid in identifying of higher-risk patients, who can then receive appropriate counseling or preoperative interventions to reduce the risk of perioperative mortality.
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Affiliation(s)
- Kevin Zhai
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Melissa Orr
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed K Emara
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Christopher A Rothfusz
- Case Western Reserve University School of Medicine, Cleveland, Ohio.,Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
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17
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Ko MS, Choi CH, Yoon HK, Yoo JH, Oh HC, Lee JH, Park SH. Risk factors of postoperative complications following total knee arthroplasty in Korea: A nationwide retrospective cohort study. Medicine (Baltimore) 2021; 100:e28052. [PMID: 35049222 PMCID: PMC9191393 DOI: 10.1097/md.0000000000028052] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/10/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The number of patients undergoing total knee arthroplasty (TKA) is gradually increasing and there is also increase in postoperative complications. The patient's demographic, socio-economic factors, hospital and clinical factors are all factors that can influence postoperative complications. The purpose of this study was to determine the risk factors associated with complications following TKA in a large national cohort. METHODS Among patients diagnosed with primary knee arthrosis, a total of 560,954 patients older than 50 years who underwent TKA from January 1, 2005 to December 31, 2018 were included in the study. The risk of postoperative complications (surgical site infection, sepsis, cardiovascular complications, respiratory complications, pulmonary embolism, stroke, acute renal failure, periprosthetic joint infection, and periprosthetic fracture) were assessed with eight independent variables: gender, age, place of residence, household income, hospital bed size, procedure type (unilateral or bilateral, primary or revision TKA), length of stay (LOS), use of transfusion. Multivariable Cox Proportional Hazard model analysis was used. The significant predictors for complications (P < .05) were as follows. RESULTS Surgical site infection: male, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Sepsis: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Cardiovascular complications: male, age, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Respiratory complications: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Pulmonary embolism: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Stroke: male, age, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Acute renal failure: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Periprosthetic joint infection: male, household income, procedure type (bilateral, revision), LOS (≥35 days), transfusion. Periprosthetic fracture: male, procedure type (bilateral, revision), LOS (≥35 days), transfusion. CONCLUSION In summary, male, procedure type (bilateral, revision), LOS (≥35 days), and use of transfusion were shown to be risk factors of postoperative complications following TKA.
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Affiliation(s)
- Min-Seok Ko
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Chong-Hyuk Choi
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Han-Kook Yoon
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea
| | - Ju-Hyung Yoo
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea
| | - Hyun-Cheol Oh
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea
| | - Jin-Ho Lee
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Sang-Hoon Park
- Department of Orthopedic Surgery, National Health Insurance Service, Ilsan Hospital, Goyang, South Korea
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18
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Kheir MM, Dilley JE, Ziemba-Davis M, Meneghini RM. The AAHKS Clinical Research Award: Extended Oral Antibiotics Prevent Periprosthetic Joint Infection in High-Risk Cases: 3855 Patients With 1-Year Follow-Up. J Arthroplasty 2021; 36:S18-S25. [PMID: 33589279 PMCID: PMC9161732 DOI: 10.1016/j.arth.2021.01.051] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/19/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Surgical and host factors predispose patients to periprosthetic joint infection (PJI) after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). While surgical factors are modifiable, host factors can be challenging, and there are limited data demonstrating that preoperative patient optimization decreases risk of PJI. The goal of this study was to evaluate whether extended oral antibiotic prophylaxis reduces the one-year infection rate in high-risk patients. METHODS A total of 3855 consecutive primary THAs and TKAs performed between 2011 and 2019 at a suburban academic hospital with modern perioperative and infection-prevention protocols were retrospectively reviewed. Beginning in January 2015, a 7-day oral antibiotic prophylaxis protocol was implemented after discharge for patients at high risk for PJI. The percentage of high-risk patients diagnosed with PJI within 1 year was compared between groups that did and did not receive extended antibiotic prophylaxis. Univariate and logistic regression analyses were performed, with P ≤ .05 denoting statistical significance. RESULTS Overall 1-year infection rates were 2.26% and 0.85% after THA and TKA, respectively. High-risk patients with extended antibiotic prophylaxis had a significantly lower rate of PJI than high-risk patients without extended antibiotic prophylaxis (0.89% vs 2.64%, respectively; P < .001). There was no difference in the infection rate between high-risk patients who received antibiotics and low-risk patients (0.89% vs 1.29%, respectively; P = .348) with numbers available. CONCLUSION Extended postoperative oral antibiotic prophylaxis for 7 days led to a statistically significant and clinically meaningful reduction in 1-year infection rates of patients at high risk for infection. In fact, the PJI rate in high-risk patients who received antibiotics was less than the rate seen in low-risk patients. Thus, extended oral antibiotic prophylaxis may be a simple measure to effectively counteract poor host factors. Moreover, the findings of this study may mitigate the incentive to select healthier patients in outcome-based reimbursement models. Further study with a multicenter randomized control trial is needed to further validate this protocol. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Michael M. Kheir
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Julian E. Dilley
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | | | - R. Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN,Indiana University Health Saxony Hip & Knee Center, Fishers, IN,Address correspondence to: R. Michael Meneghini, MD, Department of Orthopaedic Surgery, Indiana University Health Physicians Orthopedics and Sports Medicine, Indiana University School of Medicine, 13100 East 136th Street, Suite 2000, Fishers, IN 46037
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19
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Mahajan SM, Mahajan AS, Nguyen C, Bui J, Abbott BT, Osborne T. Risk Factors for Readmissions After Total Joint Replacement: A Meta-Analysis. JBJS Rev 2021; 9:01874474-202106000-00006. [PMID: 34125720 DOI: 10.2106/jbjs.rvw.20.00122] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» We performed a systematic review and meta-analysis of predictive modeling studies examining the risk of readmission after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in order to synthesize key risk factors and evaluate their pooled effects. Our analysis entailed 15 compliant studies for qualitative review and 17 compliant studies for quantitative meta-analysis. » A qualitative review of 15 predictive modeling studies highlighted 5 key risk factors for risk of readmission after THA and/or TKA: age, length of stay, readmission reduction policy, use of peripheral nerve block, and type of joint replacement procedure. » A meta-analysis of 17 studies unveiled 3 significant risk factors: discharge to a skilled nursing facility rather than to home (approximately 61% higher risk), surgery at a low- or medium-procedure-volume hospital (approximately 26% higher risk), and the presence of patient obesity (approximately 34% higher risk). We demonstrated clinically meaningful relationships between these factors and moderator variables of procedure type, source of data used for model-building, and the proportion of male patients in the cohort. » We found that many studies did not adhere to gold-standard criteria for reporting and study construction based on the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) and NOS (Newcastle-Ottawa Scale) methodologies. » We recommend that these risk factors be considered in clinical practice and future work alike as they relate to surgical, discharge, and care decision-making. Future work should also prioritize greater observance of gold-standard reporting criteria for predictive models.
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Affiliation(s)
- Satish M Mahajan
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | | | - Chantal Nguyen
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Justin Bui
- Lake Erie College of Osteopathic Medicine at Bradenton, Bradenton, Florida
| | - Bruce T Abbott
- Blaisdell Medical Library, University of California, Davis, Sacramento, California
| | - Thomas Osborne
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
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20
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Fletcher AN, Mody KS, Adams SB, DeOrio JK, Easley ME, Nunley JA. Effect of Gender Differences on Patient-Reported Outcomes and Complications in Total Ankle Replacement. Foot Ankle Int 2021; 42:776-787. [PMID: 33517772 DOI: 10.1177/1071100720985292] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate gender differences in patient outcomes and complications following total ankle replacement (TAR). METHODS Consecutive patients who underwent primary TAR from July 2007 through May 2016 were prospectively followed and retrospectively reviewed. Demographic, operative, patient-reported outcomes (PROs), and complication data were collected and analyzed. PROs included the visual analog scale (VAS), 36-Item Short-Form Health Survey (SF-36), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, and Short Musculoskeletal Function Assessment (SMFA). A total of 475 patients were evaluated, including 248 males (52.2%) and 227 females (47.8%) with an average of 56.8 months follow-up. RESULTS Women were more likely to have inflammatory arthritis (13.7% vs 2.8%; P < .01) and significantly worse preoperative SF-36 total, SF-36 mental health component, AOFAS total, AOFAS pain, SMFA function, and SMFA bother scores (all P < .05). Both genders demonstrated significant improvement in PROs at 1, 2, and 5 years. The magnitude of improvement was similar between genders for all PROs (all P < .05) with the exception of SF-36 physical function, which was greater in men. Females underwent more nonrevision reoperations (32.2% vs 22.6%; P = .0191), but there was no significant difference in failure rates (male 7.3% vs female 3.5%; P = .07). The reoperation and failure rates at 2 years postoperation were 10.1% and 1.6% for men and 18.5% and 0.9% for women, respectively. CONCLUSION Women undergoing TAR were more likely to have worse preoperative PROs and higher rates of nonrevision reoperations, which remains true when controlling for their increased incidence of inflammatory arthritis. However, women reported similar improvements in PROs and had similar prosthetic survival rates as men. Increased understanding of these disparities, combined with gender-based interventions, may further advance patient outcomes. LEVEL OF EVIDENCE Level III, therapeutic, retrospective comparative series.
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Affiliation(s)
- Amanda N Fletcher
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - Kush S Mody
- Drexel University College of Medicine & Columbia Business School, Philadelphia, PA, USA
| | - Samuel B Adams
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - James K DeOrio
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - Mark E Easley
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
| | - James A Nunley
- Department of Orthopaedics, Duke University Medical Center, Durham, NC, USA
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Understanding the Main Predictors of Length of Stay After Total Hip Arthroplasty: Patient-Related or Procedure-Related Risk Factors? J Arthroplasty 2021; 36:1663-1670.e4. [PMID: 33342668 DOI: 10.1016/j.arth.2020.11.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/12/2020] [Accepted: 11/20/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Removing total hip arthroplasty (THA) from the Centers for Medicare & Medicaid Services (CMS) inpatient-only list allows Medicare to cover outpatient THA, driving hospitals to recommend outpatient surgery for appropriate patients and raising safety concerns over which patients' admissions should remain inpatient. Thus, we aimed to determine the influence of patient-related and procedure-related risk factors as predictors of >1-day Length of Stay (LOS) after THA. METHODS A prospective cohort of 5281 patients underwent primary THA from 2016 to 2019. Risk factors were categorized as patient-related or procedure-related. Multivariable cumulative link models identified significant predictors for 1-day, 2-day, and ≥3-day LOS. Discriminating 1-day LOS from >1-day LOS, we compared performance between two regression models. RESULTS A>1-day LOS was significantly associated with age, female gender, higher body mass index, higher Charlson Comorbidity Index, Medicare status, and higher Hip disability and Osteoarthritis Outcome Physical Function Shortform(HOOS-PS) and lower Veterans RAND12 Mental Component (VR-12 MCS) scores via the initial regression model that contained patient factors only. A second regression model included procedure-related risk factors and indicated that procedure-related risk factors explain LOS more effectively than patient-related risk factors alone, as Akaike information criterion (AIC) increased by approximately 1100 units upon removal from the model. CONCLUSION Although patient-related risk factors alone provide predictive value for LOS following THA, procedure-related risk factors remain the main drivers of predicting LOS. These findings encourage examination of which specific procedural risk factors should be targeted to optimize LOS when choosing between inpatient and outpatient THA, especially within a Medicare population.
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22
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Rosario L, Jotwani R, Chen J, White RS, Aaronson JA. The economic cost of gender disparities in perioperative medicine. J Comp Eff Res 2021; 10:339-342. [PMID: 33706535 DOI: 10.2217/cer-2020-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lauren Rosario
- Department of Anesthesiology, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY 10021, USA
| | - Rohan Jotwani
- Department of Anesthesiology, Weill Cornell Medicine/NewYork-Presbyterian, New York, NY 10021, USA
| | - Jaclynn Chen
- Department of Nursing, Weill Cornell Medicine/NewYork-Presbyterian Alexandra Cohen Hospital for Women & Newborns, New York, NY 10021, USA
| | - Robert S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
| | - Jaime A Aaronson
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY 10021, USA
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23
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Moret CS, Hirschmann MT, Vogel N, Arnold MP. Customised, individually made total knee arthroplasty shows promising 1-year clinical and patient reported outcomes. Arch Orthop Trauma Surg 2021; 141:2217-2225. [PMID: 34269890 PMCID: PMC8595176 DOI: 10.1007/s00402-021-04045-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Customised individually made (CIM) implants for total knee arthroplasty (TKA) were introduced about 10 years ago. These implants aim to reduce the risk of prosthesis-related issues resulting from anthropometric differences between different knees. The purpose of this study was to analyse the short-term clinical outcome and patient reported outcome measures (PROMs) of a specific CIM implant, the ORIGIN® knee replacement system (Symbios, Yverdon-les-Bains, Switzerland), which was introduced in 2018. MATERIALS AND METHODS This is a prospective cohort study of patients undergoing primary posterior-stabilised (PS) CIM TKA using the specific ORIGIN® knee replacement system, (Symbios, Yverdon-les-Bains, Switzerland). TKAs were performed from February 2019 to October 2020. Data was collected preoperatively and postoperatively at 4 and 12 months. Outcome measures included the objective part of the Knee Society Score (KSS) with the range of motion (ROM) and the following PROMs: the Knee injury and Osteoarthritis Outcome Score (KOOS), the Forgotten Joint Score (FJS-12), the EuroQol, five dimensions, three levels (EQ-5D-3L) with the EuroQol visual analogue scale (EQ-VAS) and patient satisfaction. Differences in pre- to preoperative data were assessed with paired sample t tests. A p value < 0.05 was considered significant. RESULTS Twenty-five CIM TKA (20 patients, 8 female) were included. The mean age at surgery was 66 years (SD, 6.9). At 4 and 12 months, significant improvements in the KSS (p < 0.001), the ROM (p < 0.001), all KOOS subscales (p < 0.001), the FJS (p < 0.001) and the EQ-5D-3L (p < 0.026) were found. Satisfaction rate was 91% and 88% at 4 and 12 months, respectively. Intraoperative complications did not occur and no revision surgeries were undertaken. CONCLUSIONS The present study demonstrated significant improvements in the KSS and specific PROMs 1 year after CIM TKA. This study suggests that CIM TKA is a safe and suitable option, which can yield good clinical outcome and PROMs at least during short-term follow-up.
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Affiliation(s)
- Céline S. Moret
- Department of Orthopaedic Surgery and Traumatology, University of Basel, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Michael T. Hirschmann
- Department of Orthopaedic Surgery and Traumatology, University of Basel, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Nicole Vogel
- Practice Leonardo, Hirslanden Klinik Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
| | - Markus P. Arnold
- Practice Leonardo, Hirslanden Klinik Birshof, Reinacherstrasse 28, 4142 Münchenstein, Switzerland
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24
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Ranti D, Warburton AJ, Hanss K, Katz D, Poeran J, Moucha C. K-Means Clustering to Elucidate Vulnerable Subpopulations Among Medicare Patients Undergoing Total Joint Arthroplasty. J Arthroplasty 2020; 35:3488-3497. [PMID: 32739081 DOI: 10.1016/j.arth.2020.06.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/14/2020] [Accepted: 06/22/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of preoperative laboratory values for risk stratification following joint arthroplasty is currently ambiguous. In order to improve upon existing risk stratification within joint arthroplasty, this study sought to define novel phenotypes of total hip or total knee arthroplasty patients based entirely on preoperative laboratory measures. These phenotypes ("clusters") were compared to elucidate statistically and clinically significant differences in outcomes. METHODS A total of 134,252 patients were gathered from the National Surgical Quality Improvement Program database between 2005 and 2015. "K-means" with 3 clusters was applied using 9 preoperative laboratory values: sodium, blood urea nitrogen (BUN), creatinine, albumin, bilirubin, white blood cell count, hematocrit, platelet count, and international normalized ratio of prothrombin values (INR). Outcome measures included 30-day readmissions, severe adverse events, and discharge to nonhome. RESULTS Cluster 2 was characterized by elevated preoperative BUN, creatinine, and INR and demonstrated almost twice the rate of adverse events (3.52% vs 2.20% and 2.22%), 30-day readmissions (6.39% vs 3.31% and 3.71%), and discharge to nonhome (47.97% vs 30.50% and 35.85%). Cluster 3 was characterized by a slightly higher risk of discharge to nonhome than cluster 1 and was overwhelmingly female (79.5% female, 35.8% discharge to nonhome). Cluster 1 represents the lowest-risk subgroup, experiencing the lowest rates of readmissions, adverse events, and discharge to nonhome. CONCLUSION Preoperative laboratory values, namely BUN, creatinine, and INR, are useful in identifying patients at risk of adverse outcomes. This analysis supports the existing surgical literature pushing for preoperative hydration as a targeted intervention to expedite recovery.
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Affiliation(s)
- Daniel Ranti
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew J Warburton
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kaitlin Hanss
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Katz
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jashvant Poeran
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Population Health Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Calin Moucha
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
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25
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Assessing Preoperative Risk Factors With Sex Disparities in Total Joint Arthroplasty Patients and Financial Outcomes From the National Inpatient Sample Database. J Am Acad Orthop Surg 2020; 28:e969-e976. [PMID: 32015251 DOI: 10.5435/jaaos-d-19-00716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Disparities in the healthcare system imply potential risks for vulnerable groups whose needs are not appropriately met. Total joint arthroplasty (TJA) is successful in treating end-stage arthritis, resulting in increased demand for the procedure, however remains underused in both sexes, especially in women. Although multiple studies assessed the differences in postoperative morbidities between sexes, there remains a lack in understanding patients' preoperative clinical profile and nonclinical demographics. The aim of this study is to provide a population-based epidemiologic assessment of preoperative risk factors and sex disparities and assess differences in outcomes following TJA. METHODS The National Inpatient Sample database from 2006 to 2011 was analyzed. Patients who underwent primary total knee and hip arthroplasty were identified and stratified into two cohorts of male and female, and demographic data and comorbidities were collected. Postoperative complications, length of stay, total charges, and discharge destination were measured for matched cohorts. RESULTS Female patients present for TJAs at an older average age, are less likely to present with AIDS, alcohol abuse, coagulopathy, congestive heart failure, drug abuse, liver disease, peripheral vascular disease, and renal failure, and are more likely to present with anemia, autoimmune disorders, chronic obstructive pulmonary disease, depression, obesity, and valvular disease. Postoperatively, the average length of stay for female patients was markedly higher (3.52 versus 3.39) and a lower percentage went home (59% versus 73%). Overall, female patients experience greater odds of any complication while in-patient. DISCUSSION This study highlighted sex differences in areas that could account for the underuse of the procedure in both sexes, with women affected to a greater extent. Understanding these factors will help address the unmet needs of both sexes after TJA by encouraging future studies and provider education to ensure that all patients are able to access the necessary procedures for pain relief and functional improvement.
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26
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Choong ALC, Shadbolt C, Dowsey MM, Choong PFM. Sex-based differences in the outcomes of total hip and knee arthroplasty: a narrative review. ANZ J Surg 2020; 91:553-557. [PMID: 32954641 DOI: 10.1111/ans.16299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/30/2022]
Abstract
Total joint arthroplasty (TJA) is an effective treatment for end-stage osteoarthritis, which aims to alleviate pain and improve function and mobility. Despite the remarkable success of TJA, complications can arise, leading to unplanned hospital readmission, implant failure, morbidity and mortality. Recently, there has been a growing interest in analysing sex-based differences in diseases and response to medical interventions. This review summaries evidence pertaining to the widening gap between men and women regarding the utilization and outcome of TJA surgery. Interactions between sex and patient-reported outcome, implant failure and medical complication are complex and often demonstrate conflicting results. Significantly, there is a global consensus that men are at a higher risk of developing prosthetic joint infection following joint arthroplasty. Guided by the literature, there is a clear need for standardized methods of collecting, analysing and reporting sex-specific data to improve outcomes for both men and women who undergo TJA.
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Affiliation(s)
- Annabelle L C Choong
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Cade Shadbolt
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michelle M Dowsey
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Peter F M Choong
- Department of Surgery, The University of Melbourne, St. Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Orthopaedics, St. Vincent's Hospital, Melbourne, Victoria, Australia
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27
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Heo SM, Harris I, Naylor J, Lewin AM. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord 2020; 21:602. [PMID: 32912197 PMCID: PMC7488141 DOI: 10.1186/s12891-020-03612-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/26/2020] [Indexed: 12/11/2022] Open
Abstract
Background Total hip and total knee arthroplasty (THA/TKA) are increasing in incidence annually. While these procedures are effective in improving pain and function, there is a risk of complications. Methods Using data from an arthroplasty registry, we described complication rates including reasons for reoperation and readmission from the acute period to six months following THA and TKA in an Australian context. Data collection at 6 months was conducted via telephone interview, and included patient-reported complications such as joint stiffness, swelling and paraesthesia. We used logistic regression to identify risk factors for complications. Results In the 8444 procedures included for analysis, major complications were reported by 9.5 and 14.4% of THA and TKA patients, respectively, whilst minor complications were reported by 34.0 and 46.6% of THA and TKA patients, respectively. Overall complications rates were 39.7 and 53.6% for THA and TKA patients, respectively. In THA patients, factors associated with increased risk for complications included increased BMI, previous THA and bilateral surgery, whereas in TKA patient factors were heart disease, neurological disease, and pre-operative back pain and arthritis in a separate joint. Female gender and previous TKA were identified as protective factors for minor complications in TKA patients. Conclusion We found moderate rates of major and high rates of minor postoperative complications following THA and TKA in Australia and have identified several patient factors associated with these complications. Efforts should be focused on identifying patients with higher risk and optimising pre- and post-operative care to reduce the rates of these complications.
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Affiliation(s)
- Sung Mu Heo
- Hornsby-Kuringai Hospital, Palmerston Road, Hornsby, Sydney, NSW, 2077, Australia.
| | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - Adriane M Lewin
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, Australia
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28
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Patel AP, Gronbeck C, Chambers M, Harrington MA, Halawi MJ. Gender and Total Joint Arthroplasty: Variable Outcomes by Procedure Type. Arthroplast Today 2020; 6:517-520. [PMID: 32743033 PMCID: PMC7387670 DOI: 10.1016/j.artd.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Recent reports on the influence of gender on the outcomes of total joint arthroplasty were limited by either lack of longitudinal data or absent stratification by total hip arthroplasty (THA) or total knee arthroplasty (TKA). As a result, there remains a lack of clarity on this topic. Methods The American College of Surgeons National Surgical Quality Improvement Program was queried for all primary, elective THAs and TKAs performed between 2011 and 2017. Differences in demographics, comorbidity profiles, operative time, hospital length of stay (LOS), and 30-day outcomes were compared between male and female patients. Multivariate analyses were performed separately for THA and TKA. Results A total of 418,885 patients were analyzed; 59.1% were females. Compared with males, females were likely to be older, have a higher body mass index, identify as nonwhite, and require preoperative functional assistance (P < .001). Females had lower rates of diabetes, hypertension, anemia, and kidney disease but a higher rate of chronic steroid use (P < .001). They were also likely to have shorter operative times for both THA and TKA (P < .001). After controlling for the aforementioned differences, female gender was an independent risk factor for readmission, reoperation, and wound infection after THA (P < .001). In contrast, male sex was an independent risk factor for readmission, reoperation, and overall complications after TKA (P < .001). Regardless of the procedure, females were 64%-82% more likely to require an LOS >2 days than males. Discussion A variable effect of gender was observed on the post-total joint arthroplasty LOS and outcomes depending on the procedure type (THA or TKA). Differences attributed to gender should be accounted for in risk-stratification models. Future studies are also needed to elucidate the underlying causes of gender differences in joint arthroplasty.
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Affiliation(s)
- Aalok P. Patel
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Monique Chambers
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | | | - Mohamad J. Halawi
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
- Corresponding author. Department of Orthopaedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Suite 10A, Houston, TX 77030, USA. Tel.: +1 713 986 6016.
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29
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Thever Y, Teo BJX, Tan HCA. Predictive value of common serum glycaemic markers on periprosthetic joint infection following Total Joint Arthroplasty: A review of the literature. J Orthop 2020; 22:278-281. [PMID: 32581459 DOI: 10.1016/j.jor.2020.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/01/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022] Open
Abstract
It is well established that diabetes mellitus and osteoarthritis commonly exist together and among various treatment modalities for osteoarthritis, Total Joint Arthroplasty (TJA) has been effective. Prosthetic Joint Infection (PJI) is a serious complication of TJA with high costs and morbidity associated with it. The aim of this study is to provide background information and relevance of diabetes on PJI, and to conduct a review on existing literature, to find out if common serum glycaemic markers in diabetes could be used as predictors for PJI after TJA. These markers include measuring pre-operative glucose levels with glycated haemoglobin (HbA1c) or capillary blood glucose, peri-operative or post-operative blood glucose levels. We have found that existing literature studying these markers as predictors of PJI after TJA has been largely contentious. Despite not being used widely in clinical practice, serum fructosamine has been shown to be more reliable and accurate than the above-mentioned markers. Future studies should be carried out to confirm and better understand this association.
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Affiliation(s)
- Yogen Thever
- National University of Singapore Yong Loo Lin School of Medicine, 10 Medical Dr, 117597, Singapore
| | - Bryon Jun Xiong Teo
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
| | - Hwee Chye Andrew Tan
- Department of Orthopaedic Surgery, Singapore General Hospital, Outram Road, 169608, Singapore
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Abstract
The role of gender, race, and socioeconomic status in outcomes and satisfaction are reflected in patient-reported outcomes using measurement tools representing outcome domains. These domains include pain relief, physical and emotional functioning, adverse events, participant disposition, and patient satisfaction. Measurement tools exist for each of the outcomes in both acute and chronic pain. Patients with lower economic status have greater difficulty accessing care, are involved less in shared decision-making process, and are less satisfied with their care. Blacks, Hispanics, and Asians also have increased difficulty in accessing good quality care. Women have inferior outcomes after medical and surgical interventions.
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Affiliation(s)
- Natalie Kozlov
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA.
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31
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Ishii Y, Noguchi H, Sato J, Ishii H, Ishii R, Toyabe SI. Predictive factors for longer operative times in patients with medial knee osteoarthritis undergoing total knee arthroplasty. J Orthop 2020; 20:181-185. [PMID: 32025145 DOI: 10.1016/j.jor.2020.01.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/24/2020] [Indexed: 11/19/2022] Open
Abstract
Background Prolonged operative time has frequently been implicated as a risk factor for various complications after total knee arthroplasty (TKA). We aimed to determine whether preoperative factors such as sex, age, body mass index (BMI), prosthetic design, tibiofemoral angle (TFA), range of motion, coronal laxity, Hospital for Special Surgery score and periarticular bone mineral density (BMD) affect operative time. Methods We evaluated 164 patients (187 knees) with medial osteoarthritis who underwent primary TKA performed by a single surgeon. The medical records of 27 males and 137 females (median age of 77 and 72 years, respectively) were retrospectively reviewed. TFA was measured on non-weightbearing, standard radiographs. We used dual-energy X-ray absorptiometry to measure BMD, and an arthrometer to evaluate total coronal laxity in each patient. Results According to univariate analyses, there was a weak positive correlation between BMI and operative time (r = 0.265, p < 0.001), between TFA and operative time (r = 0.235, p = 0.001) and between BMD of the femur and tibia and operative time (r = 0.280, p < 0.001, r = 0.286, p < 0.001, respectively). No significant correlations were found between the other factors and operative time. Based on multivariate analyses, only BMD of the tibia and TFA were significantly correlated with operative time (β = 0.418, p < 0.001 and β = 0.182, p = 0.007, respectively). Conclusions TFA and BMD of the tibia were the variables more strongly correlated with operative time. Surgeons should recognize preoperatively that patients who have increased TFA, higher periarticular BMD, and higher BMI may have longer operative times. Level of evidence Level IV retrospective study.
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Affiliation(s)
- Yoshinori Ishii
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Junko Sato
- Ishii Orthopaedic & Rehabilitation Clinic, 1089 Shimo-Oshi, Gyoda, Saitama, 361-0037, Japan
| | - Hana Ishii
- Kanazawa Medical University, School of Plastic Surgery, 1-1 Daigaku Uchinada, Ishikawa, 920-0253, Japan
| | - Ryo Ishii
- Sado General Hospital, 161 Chikusa Sado, Niigata, 952-1209, Japan
| | - Shin-Ichi Toyabe
- Niigata University Crisis Management Office, Niigata University Hospital, Niigata University Graduate School of Medical and Dental Sciences, 1 Asahimachi Dori Niigata, Niigata, 951-8520, Japan
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32
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Charpentier PM, Srivastava AK, Zheng H, Ostrander JD, Hughes RE. Readmission Rates for One Versus Two-Midnight Length of Stay for Primary Total Knee Arthroplasty: Analysis of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) Database. J Bone Joint Surg Am 2019; 100:1757-1764. [PMID: 30334886 DOI: 10.2106/jbjs.18.00166] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The length of stay (LOS) in the hospital for total knee arthroplasty (TKA) has been declining over recent decades. The purpose of this study was to determine if patients with an LOS for TKA that includes only 1 midnight have an increased odds of 90-day readmission compared with those with a 2-midnight LOS. We also sought to identify any predictors of 90-day hospital readmission among those readmitted during our period of analysis. METHODS A retrospective review of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) database was performed to identify patients with a 1-midnight or 2-midnight LOS for TKA during a 5-year period. The primary end point of this study was inpatient readmission within the 90-day postoperative period. A multiple logistic regression model and propensity score matching were used to compare the odds of 90-day readmission between 1-midnight and 2-midnight LOS. The secondary end points of this study were 90-day complications. RESULTS There were 96,250 TKA procedures identified in the database, and 46,709 met our inclusion criteria for LOS. No difference in 90-day-readmission odds between patients with a 1-midnight LOS and those with a 2-midnight LOS for primary TKA was identified. Male sex, single marital status, age of ≥80 years, type-I diabetes, previous smoking, narcotic use prior to surgery, and a higher American Society of Anesthesiologists (ASA) scores increased the odds of 90-day readmission. Patients in the age group of ≥50 to <65 years, those with a higher preoperative hemoglobin level, and those with a positive social history of alcohol use were found to have decreased odds of readmission. CONCLUSIONS We found no association between the LOS for primary TKA (1 midnight compared with 2 midnights) and the 90-day readmission risk. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- P M Charpentier
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, Virginia.,Department of Orthopedic Surgery, McLaren Flint Hospital, Flint, Michigan
| | - A K Srivastava
- Department of Orthopedic Surgery, McLaren Flint Hospital, Flint, Michigan.,OrthoMichigan, Flint, Michigan
| | - H Zheng
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - J D Ostrander
- Department of Orthopedic Surgery, McLaren Flint Hospital, Flint, Michigan.,OrthoMichigan, Flint, Michigan
| | - R E Hughes
- Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan
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Shah A, Memon M, Kay J, Wood TJ, Tushinski DM, Khanna V. Preoperative Patient Factors Affecting Length of Stay following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2019; 34:2124-2165.e1. [PMID: 31182407 DOI: 10.1016/j.arth.2019.04.048] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) yields substantial improvements in quality of life for patients with severe osteoarthritis. Previous research has shown that TKA outcomes are inferior in patients with certain demographic and clinical factors. Length of stay (LOS) following TKA is a major component of costs incurred by healthcare providers. It is hypothesized that patient-related factors may influence LOS following TKA. The purpose of this systematic review and meta-analysis is to investigate these factors. METHODS Three databases (PubMed, Embase, and OVID Medline) were searched using variants of the terms "total knee arthroplasty" and "length of stay". Studies were screened and data abstracted in duplicate. The primary outcome was the effect of prognostic variables on LOS following TKA. Meta-analysis was performed using the Review Manager (RevMan) software (version 5.3. Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2014). RESULTS A total of 68 studies met all inclusion criteria for this review. These studies comprised 21,494,459 patients undergoing TKA with mean age 66.82 years (range, 15-95 years) and 63.8% (12,165,160 of 19,060,572 reported) females. The mean MINORS score was 7, suggesting that studies had a low quality of evidence. Mean LOS following TKA has steadily decreased over the past 4 decades, partially because of the implementation of fast-track programs. Demographic factors associated with increased LOS were age >70 years (mean difference [MD] = 0.81; 95% confidence interval [CI] = 0.38-1.24), female gender (MD = 0.32; 95% CI = 0.29-0.48), body mass index >30 (MD = 0.09; 95% CI = 0.01-0.16), and non-White race (MD = 0.20; 95% CI = 0.10-0.29). Clinical factors associated with increased LOS were American Society of Anesthesiologists score 3-4 vs 1-2 (MD = 1.12; 95% CI = 0.58 to 1.66), Charlson Comorbidity Index > 0 vs 0 (MD = 0.77; 95% CI = 0.32 to 1.22), and preoperative hemoglobin < 130 g/L (MD = 0.66; 95% CI = 0.34 to 0.98). CONCLUSION This systematic review and meta-analysis showed that increased age, female gender, body mass index ≥ 30, non-White race, American Society of Anesthesiologists > 2, Charlson Comorbidity Index > 0, and preoperative hemoglobin < 130 g/L were predictors of increased LOS. Mean LOS has steadily decreased over the past decades with the implementation of perioperative "fast-track" programs. Future research should investigate the benefits of preoperative risk factor modification on LOS, in addition to novel surgical approaches, anesthetic adjuvants, and physiotherapy modifications. LEVEL OF EVIDENCE IV, systematic review, and meta-analysis of level III and IV evidence.
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Affiliation(s)
- Ajay Shah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Thomas J Wood
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel M Tushinski
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Vickas Khanna
- Division of Orthopaedics, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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Basques BA, Bell JA, Fillingham YA, Khan JM, Della Valle CJ. Gender Differences for Hip and Knee Arthroplasty: Complications and Healthcare Utilization. J Arthroplasty 2019; 34:1593-1597.e1. [PMID: 31003781 DOI: 10.1016/j.arth.2019.03.064] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The influence of patient gender on complications and healthcare utilization remains unexplored. The purpose of the present study was to determine if patient gender significantly affected outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS Retrospective cohort study of THA and TKA patients was performed using the Nationwide Inpatient Sample from 2002 to 2011. Only patients who underwent elective procedures and those with complete perioperative data were included. Multivariate logistic regression was used to compare the rates of adverse events between male and female cohorts while controlling for baseline characteristics. RESULTS A total of 6,123,637 patients were included in the study (31.2% THA and 68.8% TKA). The cohort was 61.1% female. While males had a lower rate of any adverse event (odds ratio [OR] = 0.8, P < .001), urinary tract infection (OR = 0.4, P < .001), deep vein thrombosis/pulmonary embolism (OR = 0.9, P < .001), and blood transfusion (OR = 0.5, P < .001), male gender was associated with statistically significant increases in the rates of death (OR = 1.6, P < .001), acute kidney injury (OR = 1.6, P < .001), cardiac arrest (OR = 1.7, P < .001), myocardial infarction (OR = 1.6, P < .001), pneumonia (OR = 1.1, P < .001), sepsis (OR = 1.6, P < .001), surgical site infection (OR = 1.4, P < .001), and wound dehiscence (OR = 1.4, P < .001). CONCLUSION Males had increased rates of many individual adverse events. Females had higher rates of urinary tract infection, which translated to an overall higher rate of adverse events in females because of the rarity of the other individual adverse events.
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Affiliation(s)
- Bryce A Basques
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Joshua A Bell
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jannat M Khan
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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The Main Predictors of Length of Stay After Total Knee Arthroplasty: Patient-Related or Procedure-Related Risk Factors. J Bone Joint Surg Am 2019; 101:1093-1101. [PMID: 31220026 DOI: 10.2106/jbjs.18.00758] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Often, differences in length of stay after total knee arthroplasty are solely attributed to patient factors. Therefore, our aim was to determine the influence of patient-related and procedure or structural-related risk factors as predictors of length of stay after total knee arthroplasty. METHODS A prospective cohort of 4,509 patients (54.6% of whom had Medicare for insurance) underwent primary total knee arthroplasty across 4 facilities in a single health-care system (from January 1, 2016, to September 30, 2017). Risk factors were categorized as patient-related risk factors (demographic characteristics, smoking status, Veterans RAND 12 Item Health Survey Mental Component Summary score [VR-12 MCS], Charlson Comorbidity Index, surgical indication, Knee injury and Osteoarthritis Outcome Score [KOOS], deformity, range of motion, and discharge location probability assessed by a nomogram predicting location after arthroplasty) or as procedure or structural-related risk factors (hospital site, surgeon, day of the week when the surgical procedure was performed, implant type, and surgical procedure start time). Multivariable cumulative link (proportional odds logistic regression) models were built to identify significant predictors from candidate risk factors for 1-day, 2-day, and ≥3-day length of stay. Performance was compared between a model containing patient-related risk factors only and a model with both patient-related and procedure or structural-related risk factors, utilizing the Akaike information criterion (AIC) and internally validated concordance probabilities (C-index) for discriminating a 1-day length of stay compared with >1-day length of stay. RESULTS Patient-related risk factors were significant predictors of length of stay (p < 0.05). A longer length of stay was predicted by older age, higher body mass index (BMI), higher Charlson Comorbidity Index, lower VR-12 MCS, and female sex. However, when the procedure or structural factors were added to the patients' risk factors, the AIC decreased by approximately 1,670 units. This indicates that procedure or structural-related risk factors provide clinically relevant improvement in explaining length of stay in addition to patient-related risk factors. CONCLUSIONS Despite patient-related factors such as age, sex, and comorbidities providing substantial predictive value for length of stay after total knee arthroplasty, the main driving predictors of single-day length of stay after total knee arthroplasty were procedure or structural-related factors, including hospital site and surgeon. Understanding the risk factors that affect outcomes after total knee arthroplasty provides the opportunity to influence and potentially modify them favorably to optimize care.
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Is There a “Sex Effect” in 30-Day Outcomes After Elective Posterior Lumbar Fusions? World Neurosurg 2018; 120:e428-e433. [DOI: 10.1016/j.wneu.2018.08.097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/22/2022]
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