Gender Disparities in Osteoarthritis-Related Health Care Utilization Before Total Knee Arthroplasty

2016 ◽  
Vol 31 (10) ◽  
pp. 2115-2118.e1 ◽  
Author(s):  
Harpreet S. Bawa ◽  
Jack W. Weick ◽  
Douglas R. Dirschl
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Health Care Utilization ◽  
Knee Arthroplasty ◽  
Gender Disparities ◽  
Care Utilization ◽  
Total Knee

Health Care Utilization and Payer Cost Analysis of Robotic Arm Assisted Total Knee Arthroplasty at 30, 60, and 90 Days

2019 ◽  
Author(s):  
Michael A. Mont ◽  
Christina Cool ◽  
David Gregory ◽  
Andrea Coppolecchia ◽  
Nipun Sodhi ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Health Care Utilization ◽  
Knee Arthroplasty ◽  
Skilled Nursing Facility ◽  
Robotic Arm ◽  
Care Utilization ◽  
Chi Square ◽  
Total Knee ◽  
Care Costs

AbstractThis study performed a health care utilization analysis between robotic arm assisted total knee arthroplasty (rTKA) and manual total knee arthroplasty (mTKA) techniques. Specifically, we compared (1) index costs and (2) discharge dispositions, as well as (3) 30-day (4) 60-day, and (5) 90-day (a) episode-of-care costs, (b) postoperative health care utilization, and (c) readmissions. The 100% Medicare Standard Analytical Files were used for rTKAs and mTKAs performed between January 1, 2016, and March 31, 2017. Based on strict inclusion–exclusion criteria and 1:5 propensity score matching, 519 rTKA and 2,595 mTKA patients were analyzed. Total episode payments, health care utilization, and readmissions, at 30-, 60-, and 90-day time points were compared using generalized linear model, binomial regression, log link, Mann–Whitney, and Pearson's chi-square tests. The rTKA versus mTKA cohort average total episode payment was US$17,768 versus US$19,899 (p < 0.0001) at 30 days, US$18,174 versus US$20,492 (p < 0.0001) at 60 days, and US$18,568 versus US$20,960 (p < 0.0001) at 90 days. At 30 days, 47% fewer rTKA patients utilized skilled nursing facility (SNF) services (13.5 vs. 25.4%; p < 0.0001) and had lower SNF costs at 30 days (US$6,416 vs. US$7,732; p = 0.0040), 60 days (US$6,678 vs. US$7,901, p = 0.0072), and 90 days (US$7,201 vs. US$7,947, p = 0.0230). rTKA patients also utilized fewer home health visits and costs at each time point (p < 0.05). Additionally, 31.3% fewer rTKA patients utilized emergency room services at 30 days postoperatively and had 90-day readmissions (5.20 vs. 7.75%; p = 0.0423). rTKA is associated with lower 30-, 60-, and 90-day postoperative costs and health care utilization. These results are of marked importance given the emphasis to contain and reduce health care costs and provide initial economic insights into rTKA with promising results.

Total knee arthroplasty outcomes in lupus: a study using the US National Inpatient Sample

Rheumatology ◽  
2019 ◽  
Vol 58 (12) ◽  
pp. 2130-2136
Author(s):  
Jasvinder A Singh ◽  
John D Cleveland
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Health Care Utilization ◽  
Knee Arthroplasty ◽  
Care Utilization ◽  
Transfusion Rate ◽  
National Inpatient Sample ◽  
Implant Infection ◽  
The Us ◽  
Total Knee

Abstract Objective To assess whether patients with lupus have more complications and/or health care utilization than patients without lupus after primary total knee arthroplasty (TKA). Methods We used diagnostic codes to identify lupus (710.0) in patients who underwent primary TKA (procedure code, 81.54) in the US National Inpatient Sample from 1998–2014. We performed separate logistic regression analyses to assess whether lupus was associated with each in-hospital post-primary TKA complication (implant infection, implant revision, transfusion, mortality) or health care utilization for the index hospitalization. Results Our study cohort consisted of 8 127 282 primary TKAs with a mean age of 66.4 years, 63% were female, 68% White, 97% with OA, and the Deyo-Charlson comorbidity score was zero in 51%; 30 912 TKAs were performed in people with lupus. In multivariable-adjusted analyses, lupus was independently associated with a significantly higher risk of transfusion, but no significant difference in implant infection, implant revision or mortality, with respective odds ratios [ORs] (95% confidence interval [CI]) of 1.34 (1.25, 1.42), 1.38 (0.73, 2.60), 1.35 (0.83, 2.19) and 0.83 (0.34, 2.03). Lupus was independently associated with a significantly higher risk of total hospital charges above the median, the length of hospital stay >3 days (median) and discharge to an inpatient facility, respective ORs (95% CI) were 1.42 (1.22, 1.66), 1.09 (1.04, 1.15) and 1.34 (1.27, 1.41). Conclusion Our finding of higher transfusion rate and health care utilization in lupus compared with non-lupus patients undergoing primary TKA informs surgeons, patients and policy makers regarding TKA outcomes in lupus, and can also guide appropriate resource allocation.

scholarly journals Exploration of Overdose Risk Score and Postoperative Complications and Health Care Use After Total Knee Arthroplasty

2021 ◽  
Vol 4 (6) ◽  
pp. e2113977
Author(s):  
Ahmed K. Emara ◽  
Daniel Santana ◽  
Daniel Grits ◽  
Alison K. Klika ◽  
Viktor E. Krebs ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Risk Score ◽  
Knee Arthroplasty ◽  
Health Care Use ◽  
Total Knee

Factor XI Antisense Oligonucleotide for Prevention of Venous Thrombosis

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. LBA-1-LBA-1
Author(s):  
Harry Roger Buller ◽  
Claudette Bethune ◽  
Sanjay Bhanot ◽  
David Gailani ◽  
Brett P. Monia ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Antisense Oligonucleotide ◽  
Research Funding ◽  
Primary Efficacy ◽  
Intrinsic Pathway ◽  
Primary Efficacy Outcome ◽  
Efficacy Outcome ◽  
Total Knee

Abstract BACKGROUND: Patients undergoing total knee arthroplasty are at risk for postoperative venous thromboembolism (VTE). The pathogenesis of postoperative VTE is incompletely understood, but tissue factor exposed at the surgical site is thought to be the major driver through the extrinsic pathway of coagulation. Experimental data indicate that reducing factor XI (FXI), a key component of the intrinsic pathway, attenuates thrombosis without causing bleeding, but the role of FXI in postoperative VTE in humans is unknown. There is evidence that patients with congenital FXI deficiency are at a reduced risk of VTE. FXI levels can be lowered with ISIS 416858 (FXI-ASO), an antisense oligonucleotide that specifically reduces human FXI mRNA expression in the liver. To determine whether lowering FXI levels prevents VTE without increasing the risk of bleeding, we compared several doses of FXI-ASO with enoxaparin on the rates of postoperative VTE and bleeding in patients undergoing total knee arthroplasty. METHODS: We randomized 300 patients to one of two FXI-ASO regimens (200 or 300 mg) or to 40 mg enoxaparin once daily in an open-label, parallel group study. FXI-ASO was administered as 9 subcutaneous injections starting 36 days before surgery with the last dose given 3 days postoperatively. Enoxaparin was to be continued for at least 8 days postoperatively. The primary efficacy outcome was the incidence of VTE detected by mandatory bilateral venography (performed on days 8 to 12 postoperatively) or symptomatic events. The principal safety outcome was major and clinically relevant nonmajor bleeding. All outcomes were adjudicated by a committee blinded to treatment allocation. RESULTS: FXI-ASO prolonged the activated partial thromboplastin time in a dose-dependent manner, but had no effect on the prothrombin time. Around the time of surgery, mean FXI activities were 0.38 ± 0.01, 0.20 ± 0.01 and 0.93 ± 0.02 units/ml in patients given the 200 and 300 mg FXI-ASO regimens and enoxaparin, respectively. In contrast, levels of FXII, FIX and FVIII, other components of the intrinsic pathway, were unaffected by FXI-ASO. The primary efficacy outcome occurred in 36 of 134 (26.9%) and 3 of 71 (4.2%) patients given the 200 and 300 mg FXI-ASO regimens, respectively, compared with 21 of 69 (30.4%) patients in the enoxaparin group. The 200 mg regimen was non-inferior, while the 300 mg regimen was superior to enoxaparin (P<0.001). Bleeding occurred in 2.8%, 2.6% and 8.3% of patients in the 200 mg, 300 mg, and enoxaparin groups, respectively. Preoperative and postoperative hemoglobin values and transfusion requirements were similar in the three treatment groups. CONCLUSIONS: This study is the first to show that FXI contributes to postoperative VTE and that lowering FXI levels is very effective for its prevention and appears to be safe. Additional studies are needed to confirm the safety of FXI-ASO, although the fact that patients receiving this therapy safely underwent major orthopedic surgery is reassuring. Our findings support the concept that thrombosis and hemostasis can be dissociated with strategies that target FXI. The profile of FXI-ASO renders it an appealing option for treatment of patients with a wide range of chronic thrombotic conditions. Disclosures Buller: Isis Pharmaceuticals Daiichi-Sankyo Bayer Health-Care Pfizer Bristol-Myers-Squibb: Consultancy, Honoraria. Bethune:Isis Pharmaceuticals: Employment. Bhanot:Isis Pharmaceuticals: Employment. Gailani:Aronora: Consultancy, Membership on an entity's Board of Directors or advisory committees; Bayer: Consultancy, Research Funding; Bristol-Myers Squibb: Consultancy, Research Funding; Dyax: Consultancy, Research Funding; Instrument Laboratory: Consultancy, Research Funding; Isis: Consultancy; Merck: Consultancy; Novartis: Consultancy. Monia:Isis Pharmaceuticals, Inc.: Employment. Raskob:Bayer Healthcare: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Daiichi Sankyo: Consultancy, Honoraria; Janssen Pharmaceuticals: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; ISIS Pharmaceuticals: Consultancy, Honoraria. Segers:Isis Pharmaceuticals Daiichi-Sankyo Bayer Health-Care Pfizer Bristol-Myers-Squibb: Medical Director ofAcademic Research Organization which received services fees for the scientific coordination of clinical studies Other. Weitz:Pfizer, Inc.: Consultancy, Honoraria.

scholarly journals The economic impact of periprosthetic infection in total knee arthroplasty

2021 ◽  
Vol 64 (2) ◽  
Author(s):  
Mina W. Morcos ◽  
Paul Kooner ◽  
Jackie Marsh ◽  
James Howard ◽  
Brent Lanting ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Economic Impact ◽  
Health Care System ◽  
Knee Arthroplasty ◽  
Joint Infection ◽  
Accurate Estimate ◽  
Total Knee ◽  
Revision Tka ◽  
Care System

Background: Currently, the gold standard treatment for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is 2-stage revision, but few studies have looked at the economic impact of PJI on the health care system. The objective of this study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in TKA and to assess the economic impact of PJI after TKA compared to uncomplicated primary TKA. Methods: We identified consecutive patients in our institutional database who had undergone 2-stage revision TKA for PJI between 2010 and 2014 and matched them on age and body mass index with patients who had undergone uncomplicated primary TKA over the same period. We calculated all costs associated with the 2 procedures and compared mean costs, length of stay, clinical visits and readmission rates between the 2 groups. Results: There were 73 patients (mean age 68.8 [range 48–91] yr) in the revision TKA cohort and 73 patients (mean age 65.9 [range 50–86] yr) in the primary TKA cohort. Two-stage revision surgery was associated with a significantly longer hospital stay (mean 22.7 d v. 3.84 d, p <s; 0.001), more outpatient clinic visits (mean 8 v. 3, p < 0.001), more readmissions (29 v. 0, p < 0.001) and higher overall cost (mean $35 429.97 v. $6809.94, p < 0.001) than primary TKA. Conclusion: Treatment for PJI after TKA has an enormous economic impact on the health care system. Our data suggest a fivefold increase in expenditure in the management of this complication compared to uncomplicated primary TKA.

Health Care Subsidy and Outcomes of Total Knee Arthroplasty in Asians

Orthopedics ◽  
2013 ◽  
Vol 36 (6) ◽  
pp. e735-e740
Author(s):  
Hamid Rahmatullah bin Abd Razak ◽  
Toh Rui Xiang ◽  
Chong Hwei Chi ◽  
Tan Hwee Chye Andrew
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Total Knee

Maryland's Global Budget Revenue Model: How Do Costs and Readmission Rates Fare for Patients Undergoing Total Knee Arthroplasty?

2020 ◽  
Author(s):  
Ronald E. Delanois ◽  
Wayne A. Wilkie ◽  
Nequesha S. Mohamed ◽  
Ethan A. Remily ◽  
Andrew N. Pollak ◽  
...  
Keyword(s):  
Health Care ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
The United States ◽  
Morbidly Obese ◽  
Global Budget ◽  
Total Knee ◽  
The U.S ◽  
Budget Revenue

AbstractIn 2014, Maryland implemented the Global Budget Revenue (GBR) model for cost reduction and quality improvement. This study evaluated GBR's effect on demographics and outcomes for patients who underwent primary total knee arthroplasty (TKA) by comparing Maryland to the United States (U.S.). We identified primary TKA patients in Maryland's State Inpatient Database (n = 71,022) and the National Inpatient Sample (n = 4,045,245) between 2011 and 2016 utilizing International Classification of Disease (ICD)-9 and ICD-10 diagnosis codes. Multiple regression was used for difference-in-difference (DID) analyses to compare the intervention cohort (Maryland) to the nonintervention cohort (U.S.) between the pre-GBR (2011–2013) and post-GBR (2014–2016) periods. After GBR implementation, there were proportionally less white, obese, morbidly obese, Medicare, and Medicaid patients with proportionally more routine discharge patients in Maryland and the U.S. (all p < 0.001). There were proportionally less home health care (HHC) patients in Maryland, but more in the U.S. (both p < 0.001). The mean lengths of stay (LOS), costs, and complications decreased for both cohorts, while charges increased for the U.S. (all p < 0.001). The DID analysis suggested Maryland saw more Asian and Medicaid patients and less obese and morbidly obese patients under GBR. The DID assessments also found decreased LOS, costs, and charges (p < 0.001 for all) for patients under GBR. As other states such as Pennsylvania and Vermont explore hospital budgets, Maryland may provide a more viable model for future health care policies that incorporate global budgets.

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