Effects of Venous Insufficiency in Patients Undergoing Primary Total Knee Arthroplasty: An Analysis of 1.2 Million Patients

2021 ◽  
Author(s):  
Spencer Summers ◽  
Ramakanth Yakkanti ◽  
Justin Ocksrider ◽  
Sagie Haziza ◽  
Angelo Mannino ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Venous Insufficiency ◽  
Medical Complications ◽  
Administrative Claims ◽  
Readmission Rates ◽  
Costs Of Care ◽  
Episode Of Care ◽  
Total Knee ◽  
Care Costs

AbstractChronic venous insufficiency (CVI) is extraordinarily prevalent in our aging population with over 30 million people in the United States suffering from the disease. There is a paucity of data analyzing the effects of CVI on outcomes following total knee arthroplasty (TKA). The purpose of this study was to utilize a nationwide administrative claims database to determine whether patients with CVI undergoing TKA have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmission rates; (3) medical complications; (4) implant-related complications; and (5) costs of care compared to controls. Using a nationwide database, we matched patients with CVI undergoing TKA to controls without CVI undergoing TKA in a 1:5 ratio by age, sex, and medical comorbidities associated with CVI. Primary outcomes analyzed within the study included LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, in addition to 90-day total global episode of care costs. The query yielded 1,265,534 patients with (n = 210,926) and without (n = 1,054,608) CVI undergoing primary TKA. Patients with CVI had significantly longer LOS (4 vs. 3 days, p < 0.0001), higher 90-day readmission rates (20.96 vs. 15.34%; odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.44–1.48, p < 0.0001), and higher odds of medical complications (2.27 vs. 1.30%; OR: 1.76, 95% CI: 1.70–1.83, p < 0.0001) compared to matched controls. Patients with CVI also had higher odds of periprosthetic joint infections (2.23 vs. 1.03%; OR: 2.18, p < 0.0001) and implant-related complications in general (4.27 vs. 2.17%; OR: 2.01, 95% CI: 1.96–2.06, p < 0.0001). Additionally, patients with CVI had higher total global 90-day episode of care costs ($15,583.07 vs. $14,286.95, p < 0.0001). Patients with CVI undergoing TKA have increased LOS, higher odds of medical and implant complications, and increased costs of care compared to those without CVI. The study can be utilized by orthopaedic surgeons to counsel patients on the potential complications following this procedure. This is a level III, retrospective cohort study.

Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

2021 ◽  
Author(s):  
Samuel J. Swiggett ◽  
Angelo Mannino ◽  
Rushabh M. Vakharia ◽  
Joseph O. Ehiorobo ◽  
Martin W. Roche ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Administrative Claims ◽  
Readmission Rates ◽  
Costs Of Care ◽  
Lengths Of Stay ◽  
Total Knee ◽  
The Impact

AbstractThe impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.

Perioperative Complications in Patients with Rheumatoid Arthritis Following Primary Total Knee Arthroplasty: An Analysis of 102,898 Patients

2019 ◽  
Vol 32 (11) ◽  
pp. 1075-1080 ◽  
Author(s):  
Ajit M. Vakharia ◽  
Wayne B. Cohen-Levy ◽  
Rushabh M. Vakharia ◽  
Nipun Sodhi ◽  
Michael A. Mont ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Medical Complications ◽  
Readmission Rates ◽  
Episode Of Care ◽  
Total Knee ◽  
The Impact ◽  
Care Costs

AbstractThere are conflicting results regarding the impact of rheumatoid arthritis (RA) on total knee arthroplasty (TKA) outcomes. Therefore, the purpose of this study was to compare outcomes of patients with and without RA undergoing primary TKA. Specifically, we assessed (1) 90-day medical complications, (2) 90-day readmission rates, (3) short-term implant-related complications, (4) 1-year mortality, and (5) total global 90-day episode-of-care costs. The authors of the study hypothesize that RA would increase the rate of medical- and implant-related complications, readmission rates, and costs. A retrospective level of evidence III study was conducted using the Medicare standard analytical files from the PearlDiver database. Patients were queried using the International Classification of Disease, ninth revision codes. Patients with RA were randomly matched 1:1 to controls according to age, gender, and Charlson's comorbidity index. Two mutually exclusive cohorts were formed. Medical- and implant-related complications, readmission rates, and costs were analyzed and compared between the cohorts. Statistical analysis using logistic regression was performed calculating odds ratios (OR), 95% confidence intervals (95% CI), and their respective p-values. The query returned 102,898 patients with (n = 51,449) and without (n = 51,449) RA undergoing primary TKA within the Medicare database from 2005 to 2014. Patients with RA had greater odds of medical complications (OR: 2.08, 95% CI: 1.98–2.20, p < 0.001), implant complications (OR: 1.30, 95% CI: 1.24–1.36, p < 0.001), 1-year mortality (OR: 1.35, 95% CI: 0.68–2.70, p = 0.39), total 90-day episode-of-care costs ($16,605 vs. 15,716.53; p < 0.001), and 90-day readmission rates were similar between cohorts (OR: 1.08, 95% CI: 1.05–1.12, p < 0.001). RA increases postoperative complications and costs following primary TKA within Medicare patients. Comprehensive preoperative optimization for patients with a diagnosis of RA may mitigate perioperative complications, thus improving patient outcomes, and ultimately reducing episode-of-care costs.

Impact of Parkinson's Disease on Complications, Readmission Rates, and Costs of Care following Primary Total Knee Arthroplasty

2020 ◽  
Author(s):  
Kevin B. Marchand ◽  
Rushabh Vakharia ◽  
Nipun Sodhi ◽  
Hiba Anis ◽  
Hytham S. Salem ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Administrative Claims ◽  
Readmission Rates ◽  
Total Knee ◽  
Primary Total Knee

AbstractLarge-scale studies evaluating the effects of Parkinson's disease (PD) on primary total knee arthroplasty (TKA) are limited. The purpose of this study was to determine if PD patients undergoing primary TKA have increased: (1) medical complications; (2) implant-related complications; (3) readmission rates; and (4) costs. A query was performed using an administrative claims database. The study group consisted of all patients undergoing primary TKA who had a history of PD. Matched non-PD patients undergoing primary TKA served as a control group. The query yielded 72,326 patients (PD = 18,082; matching cohort = 54,244). Pearson's chi-square tests, logistic regression analyses, and Welch's t-tests were used to test for significance between the cohorts. Primary TKA patients who had PD were found to have greater incidences and odds of medical complications (4.21 vs. 1.24%; odds ratio [OR]: 3.50, 95% confidence interval [CI]: 3.15–3.89, p < 0.0001) and implant-related complications (5.09 vs. 3.15%; OR: 1.64, 95% CI: 1.51–1.79, p < 0.0001) compared with the matching cohort. Additionally, the rates and odds of 90-day readmission were higher (16.29 vs. 12.66%; OR:1.34, p < 0.0001) and episodes of care costs were significantly greater ($17,105.43 vs. $15,252.34, p < 0.0001) in patients who had PD. Results demonstrate that PD patients undergoing primary TKA had higher incidences of medical and implant-related complications. They also had increased 90-day readmission rates and costs compared with controls. The findings of this study should be used in risk stratification and should inform physician–patient discussion but should not be arbitrarily used to deny access to care.

Short-Term Outcomes Are Comparable between Robotic-Arm Assisted and Traditional Total Knee Arthroplasty

2020 ◽  
Author(s):  
Matthew J. Grosso ◽  
William T. Li ◽  
William J. Hozack ◽  
Matthew Sherman ◽  
Javad Parvizi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Multivariate Analysis ◽  
Knee Arthroplasty ◽  
Urgent Care ◽  
Robotic Arm ◽  
Short Term ◽  
Episode Of Care ◽  
Outcome Scores ◽  
Total Knee ◽  
Care Costs

AbstractRobotic-arm assisted total knee arthroplasty (rTKA) was developed to provide for increased accuracy of component placement compared with conventional manual TKA (mTKA). Whether or not rTKA is cost-effective in a bundled payment model has yet to be addressed. The purpose of this comparative study was to evaluate the short-term clinical outcomes of rTKA and mTKA. We retrospectively reviewed a series of 4,086 consecutive primary TKA performed by one of five surgeons across six different hospitals at our institution from January 2016 to December 2018. Outcomes for rTKA cases (n = 581) and mTKA cases (n = 3,505) were compared using unmatched multivariate analysis and a matched cohort. We analyzed 90-day outcomes, episode-of-care claims data, and short form (SF-12) outcome scores to 2 years postoperatively. In matched bivariate analysis, there was no difference in episode-of-care costs, postacute care costs, complications, 90-day readmission rates, emergency department/urgent care visits, reoperations, and mortality between rTKA and mTKA patients (p > 0.05). Matched patients undergoing rTKA did have a shorter hospital length of stay (1.46 vs. 1.80 days, p < 0.001) and decreased rates of discharge to rehabilitation facilities (5.5 vs. 14.8%, p < 0.001). SF-12 scores were clinically similar. Multivariate analysis demonstrated no differences in any 90-day outcome. We conclude that patients undergoing rTKA have comparable costs, 90-day outcomes, and clinically similar improvements in functional outcome scores compared with mTKA patients. Further study is needed to determine whether rTKA will result in improved implant survivorship and long-term functional outcomes (Level of evidence III).

Surgical and Medical Costs for Fibromyalgia Patients Undergoing Total Knee Arthroplasty

2019 ◽  
Vol 32 (11) ◽  
pp. 1069-1074
Author(s):  
Tara Moore ◽  
Nipun Sodhi ◽  
Wayne B. Cohen-Levy ◽  
Joseph Ehiorobo ◽  
Angad Kalsi ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Complication ◽  
Medical Complications ◽  
Readmission Rates ◽  
Surgical Costs ◽  
Episodes Of Care ◽  
Comorbidity Index ◽  
Total Knee ◽  
Financial Losses

AbstractThe potential added costs of managing fibromyalgia patients after total knee arthroplasty (TKA) have not been assessed. Therefore, the purpose of this study was to perform a cost analysis of fibromyalgia versus nonfibromyalgia patients who underwent TKA. Specifically, we evaluated the following episodes of care: (1) readmission rates, (2) total costs, (3) total reimbursements, and (4) net losses for surgical and medical complications. Patients who underwent TKAs between 2005 and 2014 from the Medicare Standard Analytical Files of the PearlDiver supercomputer were propensity score matched by patients with and without fibromyalgia in a 1:1 ratio based on age, sex, and the Charlson Comorbidity Index, yielding a total of 305,510 patients distributed equally between the cohorts for analysis. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were calculated. Mean costs, total costs, and total reimbursements were assessed as along with total net losses, which were defined as total costs minus total reimbursements. Fibromyalgia patients had similar 90-day readmission rates compared with nonfibromyalgia patients (OR: 1.03; 95% CI: 1.00–1.06; p = 0.06) but incurred lower readmission costs (US$2,318,384,295 vs. US$2,534,482,404; p < 0.001). Although fibromyalgia patients had higher total reimbursements for medical complications ($27,758,057 vs. US$18,780,610; p < 0.001), the increased management costs (US$106,049,870 vs. US$66,080,469; p < 0.001) led to greater net losses (US$78,291,813 vs. US$47,299,859; p < 0.001). Similarly, although fibromyalgia patients had higher total reimbursements for surgical complications (US$94,192,334 vs. US$73,969,026; p < 0.001), the increased surgical costs (US$382,122,613 vs. US$306,359,910; p < 0.001) led to greater net losses (US$287,930,279 vs. US$232,390,884; p < 0.001). This study highlights some of the potential financial discrepancies of managing patients with fibromyalgia. Our findings suggest medical and surgical complication costs to be greater than reimbursement, resulting in overall net financial losses. These findings need to be considered in the light of health care reform and cost structuring.

Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

Medical Care ◽  
2021 ◽  
Vol 60 (2) ◽  
pp. 178-186
Author(s):  
Amy K. Rosen ◽  
Erin E. Beilstein-Wedel ◽  
Alex H.S. Harris ◽  
Michael Shwartz ◽  
Megan E. Vanneman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Community Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Readmission Rates ◽  
Total Knee

scholarly journals A nationwide comparative analysis of medical complications in fibromyalgia patients following total knee arthroplasty

2019 ◽  
Vol 7 (4) ◽  
pp. 64-64
Author(s):  
Tara Moore ◽  
Nipun Sodhi ◽  
Angad Kalsi ◽  
Rushabh M. Vakharia ◽  
Joseph O. Ehiorobo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Comparative Analysis ◽  
Knee Arthroplasty ◽  
Medical Complications ◽  
Total Knee

Results of Robotic-Assisted Versus Manual Total Knee Arthroplasty at 2-Year Follow-up

2021 ◽  
Author(s):  
Kevin B. Marchand ◽  
Rachel Moody ◽  
Laura Y. Scholl ◽  
Manoshi Bhowmik-Stoker ◽  
Kelly B. Taylor ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Physical Function ◽  
Knee Arthroplasty ◽  
Postoperative Outcomes ◽  
Medical Complications ◽  
Womac Pain ◽  
Robotic Assisted ◽  
Surgical Data ◽  
Total Knee

AbstractRobotic-assisted technology has been developed to optimize the consistency and accuracy of bony cuts, implant placements, and knee alignments for total knee arthroplasty (TKA). With recently developed designs, there is a need for the reporting longer than initial patient outcomes. Therefore, the purpose of this study was to compare manual and robotic-assisted TKA at 2-year minimum for: (1) aseptic survivorship; (2) reduced Western Ontario and McMaster Universities Osteoarthritis Index (r-WOMAC) pain, physical function, and total scores; (3) surgical and medical complications; and (4) radiographic assessments for progressive radiolucencies. We compared 80 consecutive cementless robotic-assisted to 80 consecutive cementless manual TKAs. Patient preoperative r-WOMAC and demographics (e.g., age, sex, and body mass index) were not found to be statistically different. Surgical data and medical records were reviewed for aseptic survivorship, medical, and surgical complications. Patients were administered an r-WOMAC survey preoperatively and at 2-year postoperatively. Mean r-WOMAC pain, physical function, and total scores were tabulated and compared using Student's t-tests. Radiographs were reviewed serially throughout patient's postoperative follow-up. A p < 0.05 was considered significant. The aseptic failure rates were 1.25 and 5.0% for the robotic-assisted and manual cohorts, respectively. Patients in the robotic-assisted cohort had significantly improved 2-year postoperative r-WOMAC mean pain (1 ± 2 vs. 2 ± 3 points, p = 0.02), mean physical function (2 ± 3 vs. 4 ± 5 points, p = 0.009), and mean total scores (4 ± 5 vs, 6 ± 7 points, p = 0.009) compared with the manual TKA. Surgical and medical complications were similar in the two cohorts. Only one patient in the manual cohort had progressive radiolucencies on radiographic assessment. Robotic-assisted TKA patients demonstrated improved 2-year postoperative outcomes when compared with manual patients. Further studies could include multiple surgeons and centers to increase the generalizability of these results. The results of this study indicate that patients who undergo robotic-assisted TKA may have improved 2-year postoperative outcomes.

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

2020 ◽  
Author(s):  
Andrew D. Ardeljan ◽  
Teja S. Polisetty ◽  
Joseph Palmer ◽  
Rushabh M. Vakharia ◽  
Martin W. Roche
Keyword(s):  
Total Knee Arthroplasty ◽  
Lower Extremity ◽  
Knee Arthroplasty ◽  
Fall Risk ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Lower Extremity Fracture ◽  
Extremity Fracture ◽  
Total Knee ◽  
Primary Total Knee

AbstractDespite the high incidence of sarcopenia in the orthopaedic community, studies evaluating the influence of sarcopenia following primary total knee arthroplasty (TKA) are limited. Therefore, the purpose of this study is to determine if sarcopenic patients undergoing primary TKA have higher rates of (1) in-hospital lengths of stay (LOS); (2) medical complications; (3) implant-related complications; (4) fall risk; (5) lower extremity fracture risk; and (6) costs of care. Sarcopenia patients were matched to controls in a 1:5 ratio according to age, sex, and medical comorbidities. The query yielded 90,438 patients with (n = 15,073) and without (n = 75,365) sarcopenia undergoing primary TKA. Primary outcomes analyzed included: in-hospital LOS, 90-day medical complications, 2-year implant-related complications, fall risk, lower extremity fracture risk, and costs of care. A p-value of less than 0.05 was considered statistically significant. Patients with sarcopenia undergoing primary TKA had greater in-hospital LOS (4 vs. 3 days, p < 0.0001). Sarcopenic patients were also found to have increased incidence and odds of 90-day medical complications (2.9 vs. 1.1%; odds ratio [OR] = 2.83, p < 0.0001), falls (0.9 vs. 0.3%; OR = 3.54, p < 0.0001), lower extremity fractures (1.0 vs. 0.2%; OR = 5.54, p < 0.0001), and reoperation (0.9 vs. 0.5%; OR = 1.87, p < 0.0001). Additionally, sarcopenic patients had greater 2-year implant-related complications (4.3 vs. 2.4%; OR = 1.80, p < 0.0001), as well as day of surgery ($52,900 vs. 48,248, p < 0.0001), and 90-day ($68,303 vs. $57,671, p < 0.0001) costs compared with controls. This analysis of over 90,000 patients demonstrates that patients with sarcopenia undergoing primary TKA have greater in-hospital LOS, increased odds of 90-day medical complications, falls, lower extremity fractures, and reoperations. Additionally, sarcopenia was associated with greater 2-year implant-related complications, day of surgery costs, and 90-day costs. The study is useful as it can allow orthopaedic surgeons to properly educate these patients of the potential complications which may occur following their surgery.

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