Crohn's Disease Increases In-Hospital Lengths of Stay, Medical Complications, and Costs of Care following Primary Total Knee Arthroplasty

Abstract

The literature has shown an increase in prevalence of Crohn's disease (CD) within the United States alongside a concomitant rise in primary total knee arthroplasty (TKA) procedures. As such, with these parallel increases, orthopaedic surgeons will invariably encounter CD patients requiring TKA. Limited studies exist evaluating the impact of this disease on patients undergoing the procedure; therefore, this study endeavors to determine whether CD patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS), (2) medical complications, and (3) episode of care (EOC) costs. To accomplish this, a nationwide database was queried from January 1, 2005 to March 31, 2014 to identify patients undergoing TKA. The study group, patients with CD, was randomly matched to the controls, patients without CD, in a 1:5 ratio after accounting for age, sex, and medical comorbidities associated with CD. Patients consuming corticosteroids were excluded, as they are at risk of higher rates of adverse events following TKA. This query ultimately yielded a total of 96,213 patients, with 16,037 in the study cohort and 80,176 in the control one. The study compared in-hospital (LOS), 90-day medical complications, and day of surgery and total global 90-day EOC costs between CD and non-CD patients undergoing primary TKA. The results found CD patients undergoing primary TKA had significantly longer in-hospital LOS (4- vs. 3 days, p < 0.0001) compared with non-CD patients. CD patients were also found to have significantly higher incidence and odds of 90-day medical complications (25.31 vs. 10.75; odds ratio: 2.05, p < 0.0001) compared with their counterparts. Furthermore, CD patients were found to have significantly higher 90-day EOC costs ($15,401.63 vs. 14,241.15, p < 0.0001) compared with controls. This study demonstrated that, after adjusting for age, sex, and medical comorbidities, patients with CD have prolonged in-hospital LOS, increased medical complications, and higher EOC costs following primary TKA. Therefore, it establishes the importance for orthopaedists to adequately counsel CD patients of the potential complications and outcomes following their procedure.

Inflammatory bowel disease is associated with an increased risk of adverse events in patients undergoing joint arthroplasty

“…The included studies were all conducted in the USA. Six studies collected data from nationwide administrative databases, 5,18,19,[21][22][23] and two from a single-centre hospital database. 20,24 Five studies reported mixed cohorts of patients suffering from IBD 5,[19][20][21]24 and three included patients with CD only.…”

“…20,24 Five studies reported mixed cohorts of patients suffering from IBD 5,[19][20][21]24 and three included patients with CD only. 18,22,23 One study investigated hip, knee, and shoulder arthroplasty, 21 two investigated hip and knee arthroplasty, 5,24 two investigated total knee arthroplasty only, 22,23 and three investigated total hip arthroplasty only. [18][19][20] The International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis codes were used to diagnose IBD in seven studies.…”

“…[18][19][20] The International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) diagnosis codes were used to diagnose IBD in seven studies. 5,18,19,[21][22][23][24] Five studies used ICD-9 procedural codes or Current Procedural Terminology codes to identify patients undergoing joint arthroplasty. 5,18,[21][22][23] Three preoperative risk assessment tools were used, including the Charlson Comorbidity Index, 24 Charlson Deyo Index, 22 and Elixhauser Comorbidity Index.…”

“…5,18,19,[21][22][23][24] Five studies used ICD-9 procedural codes or Current Procedural Terminology codes to identify patients undergoing joint arthroplasty. 5,18,[21][22][23] Three preoperative risk assessment tools were used, including the Charlson Comorbidity Index, 24 Charlson Deyo Index, 22 and Elixhauser Comorbidity Index. 18,19,21,23 Postoperative follow-up period was within 90 days of surgery in four studies, 5,18,21,23 whereas medium-term or long-term follow-up (2 to 8.9 years) was reported in four studies.…”

“…16,17 Recently, several studies have been published investigating the potential impact of IBD on postoperative outcomes in patients undergoing joint arthroplasty. 5,[18][19][20][21][22][23][24][25] These studies produced conflicting results, making it essential to take an evidence-based approach to synthesize the cohort data and draw more concrete conclusions in the context of modern surgical practice. To the best of our knowledge, no systematic review or meta-analysis has been performed to date to evaluate the impact of coexisting IBD on the clinical outcomes in joint arthroplasty patients.…”