Predictors of Facility Discharge, Range of Motion, and Patient-Reported Physical Function Improvement After Primary Total Knee Arthroplasty: A Prospective Cohort Analysis

Rissman, Cody M.; Keeney, Benjamin J.; Ercolano, Ellyn; Koenig, Karl

doi:10.1016/j.arth.2015.09.002

Cited by 53 publications

(55 citation statements)

References 25 publications

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“…Among the available variables, we focused on the following preoperative adjusters: age, 12 gender, 12 surgeon, 12 alcohol use, 18 tobacco use, 18,27 Charlson Comorbidity Score, 12 Veterans RAND-12 (VR-12) physical component score (PCS), 12,28–30 VR-12 mental component score (MCS), 31 year of surgery, bilaterality, 32 and BMI. 12,16 Additionally, the PCS improvement model also includes an adjusting variable for the time period in which postoperative PCS was captured.…”

Section: Methodsmentioning

confidence: 99%

“…12,16 Additionally, the PCS improvement model also includes an adjusting variable for the time period in which postoperative PCS was captured. Our PCS preoperative, postoperative, and both time period capture percentages are 92%, 79%, and 78%, respectively, which generally meet the PRO capture rates in the well-known AJRR, FORCE-TJR, and California Joint Replacement Registry (CJRR) registries.…”

Section: Methodsmentioning

confidence: 99%

“…We included models for predicting three different outcomes for TKA: length of stay over 3 days (LOS, no/yes), 26 facility discharge (no/yes) (Table 2), 12 and clinically significant PCS improvement, determined as an improvement of at least 5 points on the normalized 0 – 100 scale (no/yes). 15,30 We used dichotomous outcomes to enable satisfactory predictive models.…”

Section: Methodsmentioning

confidence: 99%

“…Several preoperative factors have been noted to be associated with TKA outcomes, including gender, 9–12 age, 9–13 physical function, 9,12–14 mental function, 15 body mass index, 12,16 and medical comorbidities. 12,17 Little is known about how various demographic and socioeconomic status (SES) variables are associated with TKA outcomes after adjustment for other factors, although they are studied regularly across other medical disciplines.…”

Section: Introductionmentioning

confidence: 99%

“…12,17 Little is known about how various demographic and socioeconomic status (SES) variables are associated with TKA outcomes after adjustment for other factors, although they are studied regularly across other medical disciplines. 18 Until recently, SES variables were rarely studied in Orthopaedics, particularly in rural areas for elective surgeries after adjusting for clinical, PROs, and multiple SES variables.…”

Section: Introductionmentioning

confidence: 99%

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Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population?

Keeney

Koenig

Paddock

et al. 2017

The Journal of Arthroplasty

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Background We sought to determine whether several pre-operative socioeconomic status (SES) variables meaningfully improve predictive models for primary total knee arthroplasty (TKA) length of stay (LOS), facility discharge, and clinically significant Veterans RAND-12 Physical Component Score (PCS) improvement. Methods We prospectively collected clinical data on 2,198 TKAs at a high-volume rural tertiary academic hospital from April 2011 through March 2016. SES variables included race/ethnicity, living alone, education, employment, and household income, along with numerous adjusting variables. We determined individual SES predictors and whether the inclusion of all SES variables contributed to each 10-fold cross-validated area under the model’s area under the receiver operating characteristic (AUC). We also used 1000-fold bootstrapping methods to determine whether the SES and non-SES models were statistically different from each other. Results At least 1 SES predicted each outcome. Ethnic minority patients and those with incomes<$35,000 predicted longer LOS. Ethnic minority patients, the unemployed, and those living alone predicted facility discharge. Unemployed patients were less likely to achieve PCS improvement. Without the 5 SES variables, the AUC values of the LOS, discharge, and PCS models were 0.74 (95% CI 0.72–0.77, “acceptable”; 0.86 (CI 0.84–0.87, “excellent”); and 0.80 (CI 0.78–0.82, “excellent”), respectively. Including the 5 SES variables, the ten-fold cross-validated and bootstrapped AUC values were 0.76 (CI 0.74–0.79); 0.87 (CI 0.85–0.88); and 0.81 (0.79–0.83), respectively. Conclusions We developed validated predictive models for outcomes after TKA. Although inclusion of multiple SES variables provided statistical predictive value in our models, the amount of improvement may not be clinically meaningful.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population?

Keeney

Koenig

Paddock

et al. 2017

The Journal of Arthroplasty

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The impact of surgical trainee involvement in total knee arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes

Marder

Shah

Naziri

et al. 2022

Eur J Orthop Surg Traumatol

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Resident Participation is Not Associated With Worse Outcomes After TKA

Bao

Keeney

Moschetti

et al. 2018

Clin Orthop Relat Res

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Our findings should help assure patients, residents, physicians, insurers, and hospital administrators that resident participation, after adjusting for numerous patient and clinical factors, does not have any association with key medical and financial metrics, including postoperative PCS, MCID PCS, length of stay, and facility discharge. Future research in this field should focus on whether residents affect knee-specific patient-reported outcomes such as the Knee Injury and Osteoarthritis Score and additional orthopaedic procedures, and determine how resident medical education can be further enhanced without compromising patient care and safety.Level of Evidence Level III, therapeutic study.

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Predictors of Facility Discharge, Range of Motion, and Patient-Reported Physical Function Improvement After Primary Total Knee Arthroplasty: A Prospective Cohort Analysis

Cited by 53 publications

References 25 publications

Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population?

Do Aggregate Socioeconomic Status Factors Predict Outcomes for Total Knee Arthroplasty in a Rural Population?

The impact of surgical trainee involvement in total knee arthroplasty: a systematic review of surgical efficacy, patient safety, and outcomes

Resident Participation is Not Associated With Worse Outcomes After TKA

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