Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

Abstract

Background: Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial. Objective: To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure. Methods: This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups. Results: A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62). Conclusions: Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.

Unique characteristics of end-of-life hospitalizations in Parkinson disease

“…Hospital readmission is also common among persons with PD ( Shahgholi et al, 2017 ). Although we could not determine the exact reasons for readmission in our cohort, other studies have demonstrated that readmissions among PD patients are associated with medical comorbidities, elective surgeries, and caregiver strain ( Shahgholi et al, 2017 ; Fullard et al, 2020 ). For example, persons with advanced PD become increasingly reliant on caregivers for support, and increasing physical dependence can lead to caregiver burden ( Lo Monaco et al, 2021 ; Aamodt et al, 2023b ).…”

Treatment of Postoperative Instability Following Total Knee Arthroplasty in Patients With Parkinson’s Disease

“…Some studies suggest limited additional risk with similar functional outcomes to a matched control group without PD [ 15 , 16 ] while others report the opposite, with significantly worse functional outcomes compared to controls [ 17 , 18 ]. The literature supports an increased risk of complications and readmission in TKA in patients with PD [ 4 , [19] , [20] , [21] , [22] ], with a meta-analysis by Min et al. [ 23 ] indicating PD patients had a 42% higher risk for any medical complication ( P = .004) and a 65% higher risk for any surgical complication ( P = .01) compared to a matched cohort.…”