Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

Swiggett, Samuel J.; Mannino, Angelo; Vakharia, Rushabh M.; Ehiorobo, Joseph O.; Mont, Michael A.; Erez, Orry

doi:10.1055/s-0041-1723014

Cited by 4 publications

(4 citation statements)

References 34 publications

(42 reference statements)

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“…The supercomputer houses the records of more than 150 million patients between a private payor database and the Medicare claims database. The time frame provided within the Medicare claims of the PearlDiver platform is analyzed; it has been utilized in other studies using the same database 14 15 16 17 18 19) . Due to the number of patient records available within the database, PearlDiver has been used extensively for orthopaedic-related research within all disciplines of orthopaedic surgery.…”

Section: Methodsmentioning

confidence: 99%

The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty

Horn

Diamond

et al. 2021

Hip & Pelvis

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Purpose Alcohol use disorder is a leading mental health disorder in the United States. Few studies evaluating the association of alcohol use disorder following primary total hip arthroplasty (THA) have been reported. Therefore, the purpose of this study was to determine whether patients with alcohol use disorder undergoing primary THA have higher rates of: 1) in-hospital lengths of stay (LOS); 2) complications (medical/implant-related); and 3) costs. Materials and Methods Using a nationwide claims database from January 1st, 2005 to March 31st, 2014, patients with alcohol use disorder undergoing primary THA were identified and matched to a comparison group according to age, sex, and various comorbidities, resulting in 230,467 patients who were included in the study (n=38,416) and a matched-cohort (n=192,051). Outcomes of interest included comparison of LOS, 90-day medical and 2-year implant-related complications, and costs. A P -value less than 0.002 was considered statistically significant. Results Patients with alcohol use disorder had longer in-hospital LOS (4 days vs 3 days; P <0.0001) as well as higher frequency and odds ratio (OR) of 90-day medical (45.94% vs 12.25%; OR, 2.89; P <0.0001) and 2-year implant-related complications (17.71% vs 8.46%; OR, 1.97; P <0.0001). Patients in the study group incurred higher 90-day costs of care ($17,492.63 vs $14,921.88; P <0.0001). Conclusion With the growing prevalence of alcohol use disorder in the United States, the current investigation can be utilized to evaluate the need for interventions prior to THA which can potentially minimize the rates of morbidity and mortality within this population.

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Section: Methodsmentioning

confidence: 99%

The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty

Horn

Diamond

et al. 2021

Hip & Pelvis

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“…Based on previously published studies, 8 , 9 we included several covariates that have been shown associated with our study outcomes: age (<45, 45–64, and 65+ years), sex, neighborhood income quintile, 19 rural versus urban/suburban residence, 20 comorbidity (Deyo-Charlson Comorbidity Index derived from health care use during the 2 years preceding the index surgery and grouped as 0, 1, 2, 3+), 21 surgery type (inpatient vs outpatient), and surgical anatomical site.…”

Section: Methodsmentioning

confidence: 99%

“…Studies following major elective orthopedic surgery, such as joint arthroplasty, show quality indicators are influenced by multiple factors such as age, sex, insurance status, and comorbidity. 8 , 9 One additional potential factor that has received less attention is patients’ use of health services prior to surgery. The few studies that have considered it have been limited to highly selected populations (i.e., 65+ years, US military), single institutions, or specific types of surgery.…”

Section: Introductionmentioning

confidence: 99%

High health care use prior to elective surgery for osteoarthritis is associated with poor postoperative outcomes: A Canadian population-based cohort study

Canizares,

Power,

Perruccio

et al. 2023

J Health Serv Res Policy

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Background The characterization and influence of preoperative health care use on quality-of-care indicators (e.g., readmissions) has received limited attention in populations with musculoskeletal disorders. The purpose of this study was to characterize preoperative health care use and examine its effect on quality-of-care indicators among patients undergoing elective surgery for osteoarthritis. Methods Data on health care use for 124,750 patients with elective surgery for osteoarthritis in Ontario, Canada, from April 1, 2015 to March 31, 2018 were linked across health administrative databases. Using total health care use one-year previous to surgery, patients were grouped from low to very high users. We used Poisson regression models to estimate rate ratios, while examining the relationship between preoperative health care use and quality-of-care indicators (e.g., extended length of stay, complications, and 90-day hospital readmissions). We controlled for covariates (age, sex, neighborhood income, rural/urban residence, comorbidities, and surgical anatomical site). Results We found a statistically significant trend of increasing worse outcomes by health care use gradients that persisted after controlling for patient demographics and comorbidities. Findings were consistent across surgical anatomical sites. Moreover, very high users have relatively large numbers of visits to non-musculoskeletal specialists. Conclusions Our findings highlight that information on patients’ preoperative health care use, together with other risk factors (such as comorbidities), could help decision-making when benchmarking or reimbursing hospitals caring for complex patients undergoing surgery for osteoarthritis.

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“…PearlDiver is a database which contains the records of over 150 million Medicare and private payor patients. The years analyzed within this investigation are those which are provided within the Medicare claims from the PearlDiver database, and has also been used in other previously published studies using the same platform [13][14][15][16]. Due to its extensive population size, the database has been used extensively for orthopedic-related research.…”

Section: Data Sourcementioning

confidence: 99%

How does sleep apnea impact outcomes following primary total hip arthroplasty for femoral neck fractures: a matched-control analysis

Golub

Conway

et al. 2021

Arch Orthop Trauma Surg

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Background Cross-sectional studies have demonstrated that the prevalence of sleep apnea (SA) to be increasing within the United States. While studies have shown the association of SA and its association on complications following elective orthopedic procedures, well-powered studies investigating its impact in a traumatic setting are limited. The purpose of this study was to determine whether SA patients undergoing primary total hip arthroplasty (THA) for femoral neck fractures have higher rates of: (1) hospital lengths of stay (LOS); (2) readmissions; (3) complications; and (4) healthcare expenditures. Methods The 100% Medicare Standard Analytical Files was queried from 2005 to 2014 for patients who sustained femoral neck fractures and were treated with primary THA. The study group consisted of patients with concomitant diagnoses of SA, whereas patients without SA served as controls. Study group patients were matched to controls in a 1:5 ratio by age, sex, and various comorbid conditions. Demographics of the cohorts were compared using Pearson's chi-squared analyses, and multivariate logistic regression analyses were used to calculate the odds (OR) of the effects of SA on postoperative outcomes. A p value less than 0.006 was considered to be statistically significant. ResultsThe final query yielded 24,936 patients within the study (n = 4166) and control (n = 20,770) cohorts. SA patients had significantly longer in-hospital LOS (6 vs. 5 days, p < 0.0001) but similar readmission rates (24.12 vs. 20.50%; OR: 1.03, p = 0.476). SA patients had significantly higher frequency and odds of developing medical complications (72.66 vs. 43.85%; OR: 1.57, p < 0.0001), and higher healthcare costs ($22,743.79 vs. $21,572.89, p < 0.0001). Conclusion SA is associated with longer in-hospital LOS, higher rates of complications and healthcare expenditures. This study is vital as it can allow orthopaedists to educate patients with SA on the potential complications which may occur following their procedure. Level of evidence III.

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Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

Cited by 4 publications

References 34 publications

The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty

The Association of Alcohol Use Disorder with Perioperative Complications following Primary Total Hip Arthroplasty

High health care use prior to elective surgery for osteoarthritis is associated with poor postoperative outcomes: A Canadian population-based cohort study

How does sleep apnea impact outcomes following primary total hip arthroplasty for femoral neck fractures: a matched-control analysis

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