Hypothyroidism Increases 90-Day Complications and Costs Following Primary Total Knee Arthroplasty

Buller, Leonard T.; Rosas, Samuel; Sabeh, Karim; McLawhorn, Alexander S.; Barsoum, Wael K.

doi:10.1016/j.arth.2017.10.053

Cited by 42 publications

(61 citation statements)

References 41 publications

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“…CCI served as a marker to ensure that study group patients were properly matched to controls and no statistical difference existed between the cohorts, as used in previous studies. 14,15,17 Following the matching process, two mutually exclusive cohorts were formed.…”

Section: Methodsmentioning

confidence: 99%

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients

et al. 2019

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There are conflicting results regarding the impact of rheumatoid arthritis (RA) on total knee arthroplasty (TKA) outcomes. Therefore, the purpose of this study was to compare outcomes of patients with and without RA undergoing primary TKA. Specifically, we assessed (1) 90-day medical complications, (2) 90-day readmission rates, (3) short-term implant-related complications, (4) 1-year mortality, and (5) total global 90-day episode-of-care costs. The authors of the study hypothesize that RA would increase the rate of medical- and implant-related complications, readmission rates, and costs. A retrospective level of evidence III study was conducted using the Medicare standard analytical files from the PearlDiver database. Patients were queried using the International Classification of Disease, ninth revision codes. Patients with RA were randomly matched 1:1 to controls according to age, gender, and Charlson's comorbidity index. Two mutually exclusive cohorts were formed. Medical- and implant-related complications, readmission rates, and costs were analyzed and compared between the cohorts. Statistical analysis using logistic regression was performed calculating odds ratios (OR), 95% confidence intervals (95% CI), and their respective p-values. The query returned 102,898 patients with (n = 51,449) and without (n = 51,449) RA undergoing primary TKA within the Medicare database from 2005 to 2014. Patients with RA had greater odds of medical complications (OR: 2.08, 95% CI: 1.98–2.20, p < 0.001), implant complications (OR: 1.30, 95% CI: 1.24–1.36, p < 0.001), 1-year mortality (OR: 1.35, 95% CI: 0.68–2.70, p = 0.39), total 90-day episode-of-care costs ($16,605 vs. 15,716.53; p < 0.001), and 90-day readmission rates were similar between cohorts (OR: 1.08, 95% CI: 1.05–1.12, p < 0.001). RA increases postoperative complications and costs following primary TKA within Medicare patients. Comprehensive preoperative optimization for patients with a diagnosis of RA may mitigate perioperative complications, thus improving patient outcomes, and ultimately reducing episode-of-care costs.

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Section: Methodsmentioning

confidence: 99%

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients

et al. 2019

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“…Pearl Diver is compliant with the Health Information Portability and Affordability Act (HIPAA) and holds the records of over 100 million patients and has been used extensively for orthopaedic-related research. 6 Information such as diagnosis, complications, procedures, length of stay, average charges, region, and demographics are available through the database. Since the database contains deidentified information, the study was exempt from International Review Board (IRB) approval.…”

Section: Methodsmentioning

confidence: 99%

“…CCI was used as a marker to ensure that patients in both cohorts were properly matched and there was no statistical difference between the cohorts; as used in previous studies. 6 Medical and implant related complications were also queried with the use of ICD-9 codes (►Table 1). The medical complications assessed include: acute posthemorrhagic anemia (APA), acute kidney failure (AKF), acute pancreatitis, cerebrovascular accidents (CVA), deep vein thrombosis (DVT), digestive system complications (DSC), hematoma, hemorrhage, myocardial infarction (MI), nonhealing surgical wound (NHSW), other postoperative infection (OPI), paralytic ileus, phlebitis, pneumonia, renal failure (RF), seroma, thrombocytopenia, transfusion, and urinary tract infection (UTI).…”

Section: Methodsmentioning

confidence: 99%

“…4 The literature demonstrates hypothyroidism to be an independent risk factor for postoperative complications following primary total knee arthroplasty (TKA). 5,6 Tan et al found that hypothyroid patients were at greater odds of developing periprosthetic joint infections compared with controls. 5 Similarly, in a retrospective study by Buller et al, hypothyroid patients were at greater odds of developing thromboembolic complications, pneumonia, periprosthetic fractures, which was overall associated with an increased care of cost.…”

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confidence: 99%

“…5 Similarly, in a retrospective study by Buller et al, hypothyroid patients were at greater odds of developing thromboembolic complications, pneumonia, periprosthetic fractures, which was overall associated with an increased care of cost. 6 The number of primary total hip arthroplasty (THA) procedures continues to increase but data are limited about the effects of hypothyroidism after primary THA. 7 The purpose of the study was to determine whether hypothyroid patients undergoing primary THA were at increased risk for (1) postoperative complications, (2) readmission rates, and (3) reimbursement rates compared with a matched cohort.…”

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Hypothyroidism Increases 90-Day Complications and Cost Following Primary Total Hip Arthroplasty

et al. 2019

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Hypothyroidism is common, and the incidence has been increasing annually in the United States. Abnormalities in thyroid hormone can have several effects on the endocrine, immune, and musculoskeletal systems of the body. The influence of hypothyroidism on outcomes following primary total hip arthroplasty (THA) is not well reported. The authors hypothesized that hypothyroidism was associated with a higher risk of postoperative complications and 90-day costs following primary THA. A retrospective review from 2005 to 2014 was performed using the Medicare Standard Analytical Files from the Pearl Diver database. Utilizing International Classification of Disease 9th revision (ICD-9) codes, the authors identified patients who underwent THA. Patients with a concurrent diagnosis of hypothyroidism were matched by age, gender, and Charlson's comorbidity index (CCI) to a control group. Ninety-day postoperative complications, readmission rates, complications related to implants, and cost of care were compared and assessed following primary THA between matched cohorts. Statistical analysis was performed using the programming language R (University of Auckland) to calculate odds ratios (OR) along with their respective 95% confidence intervals (95% CI), and p-values. A total of 383,898 patients underwent primary THA. Among them, 191,949 patients were diagnosed with hypothyroidism and 191,949 patients without hypothyroidism. Hypothyroidism was associated with greater odds of postoperative complications (p < 0.001), 90-day readmission rates (p < 0.001), implant related complications (p < 0.001), and total global 90-day episode of care cost (U.S. $17,549.96 vs. $16,645.01; p < 0.001). This study demonstrated an increased risk of postoperative complications (medical or implant related), increased readmission rates, and higher costs among patients with hypothyroidism following primary THA. Surgeons should counsel patients and determine strategies to medically optimize patients to mitigate risk and decrease cost.

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Medical Optimization of the Patient Prior to Surgery

Bolton¹,

Kandhari²,

Coolican³

2021

Infection in Knee Replacement

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Hypothyroidism Increases 90-Day Complications and Costs Following Primary Total Knee Arthroplasty

Cited by 42 publications

References 41 publications

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients

Hypothyroidism Increases 90-Day Complications and Cost Following Primary Total Hip Arthroplasty

Medical Optimization of the Patient Prior to Surgery

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