Is Hepatitis C Infection Associated With a Higher Risk of Complications After Total Shoulder Arthroplasty?

Abstract

Background Despite recent advances in the treatment of hepatitis C, it is estimated that nearly 4 million Americans have a chronic form of the disease. Although research in lower-extremity arthroplasty suggests patients with hepatitis C are at risk for increased complications, including postoperative bleeding, acute postoperative infection, and general medical complications, no similar studies have investigated this question in patients undergoing total shoulder arthroplasty (TSA). Questions/purposes We asked whether there is an increased risk of postoperative complications after TSA among patients who have hepatitis C, and if so, what complications in particular seem more likely to occur in this population? Methods Patients who underwent TSA, including anatomic or reverse TSA, were identified in the PearlDiver database using ICD-9 procedure codes. This is a for-fee insurance patient-records database that contains more than 100 million individual patient records from 2005 to 2012. The Medicare data in the database are the complete 100% Medicare Standard Analytical File indexed to allow for patient tracking with time. Patients with hepatitis C who underwent shoulder arthroplasty then were identified using ICD-9 codes. Patients with hepatitis B coinfection or HIV were excluded. A control cohort of patients without hepatitis C who underwent TSA was created and matched to the study cohort based on age, sex, obesity, and diabetes mellitus. A total of 1466 patients with hepatitis C and 21,502 control patients were included. The two cohorts were statistically similar in terms of sex (53% females in study and control groups), age (nearly 1 . 2 of each cohort younger than 65 years), obesity (approximately 17% of each cohort were obese), diabetes (approximately 40% of each cohort had diabetes), and followup of each cohort occurred throughout the length of the database from 2005 to 2012. Postoperative complications were assessed using ICD-9 and Current Procedural Terminology codes and compared between cohorts.

Comparative Analysis on the Effects of Sarcopenia following Primary Total Knee Arthroplasty: A Retrospective Matched-Control Analysis

“…Rates of ICD-9 coding errors within the Medicare population are reported to be 1.3%. 28,29 Additionally, due to the dichotomous nature of ICD-9 generated inclusion criteria, sarcopenia severity was not quantifiable. While the diagnosis of sarcopenia requires the use of certain criterion, we were unable to assess what specific criteria were used for the patients in our study.…”

Is There an Association Between Hemoglobin A1C and Deep Postoperative Infection After TKA?

“…Therefore, although this is a major potential limitation when using administrative databases such as PearlDiver, the overall coding error rate likely mirrors that in larger Medicare populations. Second, there is an inevitable amount of attrition or leakage that occurs from all registries such as the PearlDiver database, and these studies must be viewed in the context of this limitation [3,7,32]. As earlier noted, we have estimated the absolute minimum number of patients with 1 year followup for the current study to 86%.…”

“…Furthermore, while a ROC analysis determined that an HbA1c level greater than 8.0 mg/dL might serve as a threshold for an increased risk of deep postoperative infection after TKA, our AUC analysis indicated that the accuracy of this threshold as an independent predictor for postoperative infection after TKA was poor and of limited clinical utility. Our study has several limitations, many of which are inherent to all studies using large administrative databases [3,7,8]. First, the power of our analysis relies on the quality of the available data and the accuracy of procedural coding in the database.…”

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

“…Being a database analysis study, the validity of our findings is reliant on the accuracy of procedural coding within the database. 31 Currently, it is estimated that 1.3% of coding errors are present within the Medicare population. 31 As a result, the prevalence of comorbid conditions and adverse events may be underreported.…”

“…31 Currently, it is estimated that 1.3% of coding errors are present within the Medicare population. 31 As a result, the prevalence of comorbid conditions and adverse events may be underreported. 32 Additionally, our study only looked at a single insurer's database, and may not be an accurate representation of patients with hypothyroidism in the United States.…”