National Inpatient Datasets May No Longer Be Appropriate for Overall Total Hip and Knee Arthroplasties Projections after Removal from Inpatient-Only Lists

Rullán, Pedro J.; Pasqualini, Ignacio; Klika, Alison K.; Koroukian, Siran M.; Barsoum, Wael K.; Piuzzi, Nicolás S.

doi:10.1055/a-2037-6323

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…The future demand for TJAs was estimated by reviewing the NIS database [16][17][18] to obtain the number of THAs and TKAs performed from 2008 to 2017 (see Appendix Table A1). The International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and ICD-10) codes specific for primary THA and TKA were used to identify procedures.…”

Section: Projected Tja Volumementioning

confidence: 99%

The Arthroplasty Surgeon Growth Indicator

Rullán

Deren

Klika

et al. 2023

Journal of Bone and Joint Surgery

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Background:Orthopaedic practices in the U.S. face a growing demand for total joint arthroplasties (TJAs), while the orthopaedic workforce size has been stagnant for decades. This study aimed to estimate annual TJA demand and orthopaedic surgeon workforce supply from 2020 to 2050, and to develop an arthroplasty surgeon growth indicator (ASGI), based on the arthroplasty-to-surgeon ratio (ASR), to gauge nationwide supply and demand trends.Methods:National Inpatient Sample and Association of American Medical Colleges data were reviewed for individuals who underwent primary TJA and for active orthopaedic surgeons (2010 to 2020), respectively. The projected annual TJA volume and number of orthopaedic surgeons were modeled using negative binominal and linear regression, respectively. The ASR is the number of actual (or projected) annual total hip (THA) and/or knee (TKA) arthroplasties divided by the number of actual (or projected) orthopaedic surgeons. ASGI values were calculated using the 2017 ASR values as the reference, with the resulting 2017 ASGI defined as 100.Results:The ASR calculation for 2017 showed an annual caseload per orthopaedic surgeon (n = 19,001) of 24.1 THAs, 41.1 TKAs, and 65.2 TJAs. By 2050, the TJA volume was projected to be 1,219,852 THAs (95% confidence interval [CI]: 464,808 to 3,201,804) and 1,037,474 TKAs (95% CI: 575,589 to 1,870,037). The number of orthopaedic surgeons was projected to decrease by 14% from 2020 to 2050 (18,834 [95% CI: 18,573 to 19,095] to 16,189 [95% CI: 14,724 to 17,655]). This would yield ASRs of 75.4 THAs (95% CI: 31.6 to 181.4), 64.1 TKAs (95% CI: 39.1 to 105.9), and 139.4 TJAs (95% CI: 70.7 to 287.3) by 2050. The TJA ASGI would double from 100 in 2017 to 213.9 (95% CI: 108.4 to 440.7) in 2050.Conclusions:Based on historical trends in TJA volumes and active orthopaedic surgeons, the average TJA caseload per orthopaedic surgeon may need to double by 2050 to meet projected U.S. demand. Further studies are needed to determine how the workforce can best meet this demand without compromising the quality of care in a value-driven health-care model. However, increasing the number of trained orthopaedic surgeons by 10% every 5 years may be a potential solution.

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Section: Projected Tja Volumementioning

confidence: 99%

The Arthroplasty Surgeon Growth Indicator

Rullán

Deren

Klika

et al. 2023

Journal of Bone and Joint Surgery

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“…This paper specifically focuses on CPSP related to total knee arthroplasty (TKA) surgery. In the United States, total knee arthroplasty is one of the most performed orthopedic surgeries, with approximately 480,000 primary TKAs performed in 2019 and projections estimating between 800 thousand and 1.2 million TKAs annually in the 2040s/50s [17,18]. Studies have shown a high satisfaction rate in post-TKA patients (70-88%) based on pain reduction and functional improvement, and patients are often recorded as making notable progress in function and pain reduction between 3 to 6 months post-surgery [19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Acute Postoperative Pain in Developing Chronic Pain after Total Knee Arthroplasty

Knezevic,

Syed,

Kabir

et al. 2024

Neurology International

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While total knee arthroplasties (TKAs) are performed with the intent to reduce pain, chronic postsurgical pain (CPSP) is one of the most well-documented complications that can occur following surgery. This study aimed to assess whether perioperative factors, focusing on acute postsurgical pain and perioperative opioid consumption, were associated with the development of chronic postsurgical pain. Under general anesthesia, 108 patients underwent TKA and were treated postoperatively with a multimodal analgesia approach. Numeric Rating Scale (NRS) pain scores at rest and with movement were recorded on postoperative days 0–3, 7, 14, and 30. Patients were sent a survey to assess chronic pain at months 22–66, which was examined as a single-group post hoc analysis. Based on the responses, patients were either classified into the CPSP or non-CPSP patient group. Chronic postsurgical pain was defined as an NRS score ≥ 4 with movement and the presence of resting pain. The primary outcome was a change in NRS. There were no differences in NRS pain scores with movement in the first 30 days postoperatively between patients with CPSP and without CPSP. Each unit increase in resting pain on postoperative days 3 and 14 was associated with significantly greater odds of CPSP presence (OR = 1.52; OR = 1.61, respectively), with a trend towards greater odds of CPSP at days 7 and 30 (OR = 1.33; OR = 1.43, respectively). We found that very intense pain in the initial phase seems to be related to the development of CPSP after TKA.

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“…2 Recent estimates project this growth to continue, 3 models from different periods estimate approximately 0.8 and 1.0 million TKA cases by 2050 in the United States. 4 In China, a recent report showed the case number of TKA increased from 53,880 in the year 2011 to 374,833 in the year 2019, with a dramatic 5.9-fold increase. 5 However, despite being a mature technique, TKA has postoperative complications including pain, wound oozing, and infection.…”

Section: Introductionmentioning

confidence: 99%

“…With the population aging, the annual number of TKAs performed has markedly increased 2 . Recent estimates project this growth to continue, 3 models from different periods estimate approximately 0.8 and 1.0 million TKA cases by 2050 in the United States 4 . In China, a recent report showed the case number of TKA increased from 53,880 in the year 2011 to 374,833 in the year 2019, with a dramatic 5.9‐fold increase 5 …”

Section: Introductionmentioning

confidence: 99%

A Novel Infrapatellar Fat Pad Preservation Technique in Total Knee Arthroplasty Reduced Postoperative Pain and Wound Complications

Zhang,

Lin

et al. 2024

Orthopaedic Surgery

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ObjectiveThe management of the infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) remains controversial. This study aimed to evaluate a novel IPFP preservation technique—“the medially pedicled IPFP flap”—for reducing postoperative pain, wound complications, and improving functional recovery after TKA.MethodsA retrospective analysis was conducted on TKA cases at our institution from 2018 to 2021, including those with IPFP preservation (medially pedicled flap) versus IPFP complete resection. Patient demographics, perioperative parameters (blood loss, operative time, length of hospital stay, visual analogue scale [VAS] score, white cell count [WBC], C‐reactive protein [CRP], erythrocyte sedimentation rate [ESR], and wound oozing), and postoperative follow‐up data (VAS, Knee Society [KSS], or Knee Society functional assessment [KSFA] scores) were compared between groups. Independent sample t‐tests were used to compare continuous data and chi‐squared tests were used to compare categorical data between groups.ResultsSix hundred thirty patients were included, with 278 in the medial pedicled IPFP flap group (preservation group) and 352 in the IPFP resection group (resection group). The operative time was significantly shorter in the preservation versus resection group (125.5 ± 23.2 vs 130.3 ± 28.7 mins, p = 0.03), as was the length of hospital stay (8.4 ± 2.7 vs 9.2 ± 2.3 days, p < 0.01). Regarding pain, the preservation group had significantly lower VAS scores on postoperative day 2 (2.0 ± 0.8 vs 2.4 ± 1.2, p < 0.001) and day 3 (1.5 ± 0.5 vs 1.8 ± 1.0, p < 0.001). CRP and ESR levels on postoperative day 5 were also significantly lower in the preservation group. Wound oozing rates were significantly lower in the preservation versus resection group (0.7% vs 2.8%, p = 0.04). No significant differences existed in VAS, KSS, or KSFA scores at the last follow‐up.ConclusionThe novel IPFP preservation technique significantly improved surgical exposure, shortened operative time and length of hospital stay. It also reduced wound pain and oozing compared to IPFP resection.

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National Inpatient Datasets May No Longer Be Appropriate for Overall Total Hip and Knee Arthroplasties Projections after Removal from Inpatient-Only Lists

Cited by 4 publications

References 20 publications

The Arthroplasty Surgeon Growth Indicator

The Arthroplasty Surgeon Growth Indicator

The Impact of Acute Postoperative Pain in Developing Chronic Pain after Total Knee Arthroplasty

A Novel Infrapatellar Fat Pad Preservation Technique in Total Knee Arthroplasty Reduced Postoperative Pain and Wound Complications

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