Comorbidities in Patients Undergoing Total Knee Arthroplasty: Do They Influence Hospital Costs and Length of Stay?

Abstract

Background Increasing national expenditures and use associated with TKA have resulted in pressure to reduce costs through various reimbursement cuts. However, within the arthroplasty literature, few studies have examined the association of medical comorbidities on resource use and length of stay after joint arthroplasty. Questions/purposes The purpose of this study was to examine the association between individual patient characteristics (including demographic factors and medical comorbidities) on resource allocation and length of stay (LOS) after TKA. Methods We queried the 2009 Nationwide Inpatient Sample dataset for International Classification of Diseases, 9 th Revision code, 81.54, for TKAs. An initial 621,029-patient cohort was narrowed to 516,745 after inclusion of elective TKAs on patients aged between 40 and 95 years. Using generalized linear models, we estimated the effect of comorbidities on resource use (using cost-to-charge conversions to estimate hospital costs) and the LOS controlling for patient and hospital characteristics. Across the 2009 national cohort with TKAs, 12.7% had no comorbidities, whereas 32.6% had three or more. The most common conditions included hypertension (67.8%), diabetes (20.0%), and obesity (19.8%). Mean hospital costs were USD 14,491 (95% confidence interval [CI],14,525) and mean hospital LOS was 3.3 days (95% CI,

Understanding barriers and facilitators to healthy eating and physical activity from patients either before and after knee arthroplasty

“…Given patients were interviewed within 3 months of the surgery, it was expected that physical limitations would emerge as a main activity barrier. Additionally, over 85% of TKA patients have comorbidities [36]; thus, it is likely that these other health issues may be contributing to the nonknee-related physical limitations. Many patients’ expectations regarding the timing of recovery and functional capabilities are high prior to the surgery and often go unmet.…”

Perioperative predictors of prolonged length of hospital stay following total knee arthroplasty: a retrospective study from a single center in China

“…In recent decades, there has been a considerable amount of progress in reducing the LOS [5] because many potential factors for prolonged LOS have been studied, including age, sex, comorbidities, weekend admission, the American Society of Anesthesiologists (ASA) classification, preoperative education, and the need for blood transfusion [6][7][8][9][10][11][12][13]. Additionally, with the introduction of fast-track protocols, which emphasize pain and blood management, limit perioperative complications, and promote postoperative early ambulation, the LOS has decreased dramatically without compromising functional recovery [4,6].…”

Use of a Publicly Available Database to Determine the Impact of Diabetes on Length of Hospital Stay for Elective Orthopedic Procedures in California

“…22 Elsewhere, others have reported that patients with multiple comorbidities do have a longer LOS after knee surgery, and that diabetes was the second most common condition, increasing LOS by 20%. 20 Norris and Parker also have shown an increased risk of *The Chronic Disability Payment System model defines 2 severity levels for type 1 diabetes (High and Medium) and 2 levels for type 2 diabetes (Medium and Low). For cardiac and kidney comorbidities, there are 4 levels of severity.…”