Primary total hip arthroplasty complications and costs in liver transplant recipients: a matched analysis using a national database

2021 ◽  
pp. 112070002110372
Author(s):  
Scott J Douglas ◽  
Ethan A Remily ◽  
Oliver C Sax ◽  
Sahir S Pervaiz ◽  
Nequesha S Mohamed ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Liver Transplant ◽  
Hip Arthroplasty ◽  
Cost Of Care ◽  
National Database ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Total Hip ◽  
Obesity And Diabetes ◽  
Liver Transplant Recipients

Background: The number of liver transplant recipients (LTR) is worldwide increasing and, as the survival is improving as well, there is an increasing number of patients needing total hip arthroplasty (THA). There might be increased risks for this specific group of patients and due to their comorbidities costs might be higher too. Using a big national database outcome and cost of THA should be compared between liver transplant recipients and the general population. Methods: The study was performed using a collection of Medicare, Medicaid, and private insurance claims. Length of stay (LOS), 30-day readmissions, complications rates up to 5 years, and 90-day total cost of care between liver transplant recipients and matched non-transplant patients should be compared. All primary THAs from 2010 to 2019 were identified. 513 patients with a liver transplant before their THA were matched to 10,759 patients without a history of solid organ transplant at a 1:20 ratio based on age, sex, Charlson Comorbidity Index, obesity, and diabetes status. Results: LTR had a longer average LOS (4.2 vs. 3.4 days, p < 0.001). There was no difference in the thirty-day readmissions (5.7% vs. 4.1%, p  = 0.117) and 90-day dislocation rates (2.9% vs. 2.4%, p  = 0.600). Total costs in the first ninety days after THA were not different between the LTR and controls ( p  = 0.756). Conclusions: These findings suggest that complications and costs are no major point of concern in patients with liver transplant that are operated with THA.

scholarly journals Comparison of Three Cellular Assays to Predict the Course of CMV Infection in Liver Transplant Recipients

Vaccines ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 88
Author(s):  
Smaranda Gliga ◽  
Melanie Fiedler ◽  
Theresa Dornieden ◽  
Anne Achterfeld ◽  
Andreas Paul ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Cellular Assays ◽  
Risk Patients ◽  
Ifn Γ ◽  
Liver Transplant Recipients

To estimate protection from cytomegalovirus (CMV) replication after solid organ transplantation, CMV serology has been considered insufficient and thus CMV immunity is increasingly assessed by cellular in vitro methods. We compared two commercially available IFN-γ ELISpot assays (T-Track CMV and T-SPOT.CMV) and an IFN-γ ELISA (QuantiFERON-CMV). Currently, there is no study comparing these three assays. The assays were performed in 56 liver transplant recipients at the end of antiviral prophylaxis and one month thereafter. In CMV high- or intermediate-risk patients the two ELISpot assays showed significant correlation (p < 0.0001, r > 0.6) but the correlation of the ELISpot assays with QuantiFERON-CMV was weaker. Results of both ELISpot assays were similarly predictive of protection from CMV-DNAemia ≥500 copies/mL [CMV pp65 T-SPOT.CMV at the end of prophylaxis: area under curve (AUC) = 0.744, cut-off 142 spot forming units (SFU), sensitivity set to 100%, specificity 46%; CMV IE-1 T-Track CMV at month 1: AUC = 0.762, cut-off 3.5 SFU, sensitivity set to 100%, specificity 59%]. The QuantiFERON-CMV assay was inferior, reaching a specificity of 23% when setting the sensitivity to 100%. In conclusion, both CMV-specific ELISpot assays appear suitable to assess protection from CMV infection/reactivation in liver transplant recipients.

Conversion vs Primary Total Hip Arthroplasty: Increased Cost of Care and Perioperative Complications

2018 ◽  
Vol 33 (8) ◽  
pp. 2405-2411 ◽  
Author(s):  
Sean P. Ryan ◽  
Marcus DiLallo ◽  
David E. Attarian ◽  
William A. Jiranek ◽  
Thorsten M. Seyler
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Cost Of Care ◽  
Total Hip ◽  
Primary Total Hip Arthroplasty

Trends in Total Hip Arthroplasty Under the Patient Protection and Affordable Care Act: A National Database Analysis Between 2008 and 2015

Orthopedics ◽  
2018 ◽  
Vol 41 (4) ◽  
pp. e534-e540 ◽  
Author(s):  
Jennifer I. Etcheson ◽  
Nicole E. George ◽  
Chukwuweike U. Gwam ◽  
James Nace ◽  
Alexander T. Caughran ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Affordable Care Act ◽  
National Database ◽  
Database Analysis ◽  
Total Hip ◽  
Patient Protection

scholarly journals Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme: A qualitative study

2020 ◽  
pp. 1357633X1990045 ◽  
Author(s):  
Amandine Barnett ◽  
Katrina L Campbell ◽  
Hannah L Mayr ◽  
Shelley E Keating ◽  
Graeme A Macdonald ◽  
...  
Keyword(s):  
Liver Transplant ◽  
Solid Organ Transplantation ◽  
Exercise Programme ◽  
Lifestyle Changes ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Eating Pattern ◽  
Face To Face ◽  
Liver Transplant Recipients ◽  
Lifestyle Programme

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) ‘impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) ‘adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) ‘increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.

Age matters when comparing hemiarthroplasty and total hip arthroplasty for femoral neck fractures in Medicare patients

2018 ◽  
Vol 29 (6) ◽  
pp. 674-679 ◽  
Author(s):  
Scott M Eskildsen ◽  
Ganesh V Kamath ◽  
Daniel J Del Gaizo
Keyword(s):  
Total Hip Arthroplasty ◽  
Femoral Neck ◽  
Hip Arthroplasty ◽  
Femoral Neck Fractures ◽  
National Database ◽  
Medicare Patient ◽  
Entire Study ◽  
Total Hip ◽  
Significant Difference ◽  
Medicare Patients

Introduction: The optimal treatment of patients with a displaced intracapsular femoral neck fracture remains controversial. We utilised a national database of Medicare patients to determine if there was any difference in complications and reoperation rate of patients undergoing total hip arthroplasty (THA) or hemiarthroplasty (HA) for femoral neck fractures. Methods: This study utilised the PearlDiver Patient Records Database, a national for-fee database of Medicare patient procedure and diagnosis records from 2005 to 2012. Outcome procedures and diagnoses including revision, dislocation, infection, and cardiovascular events that occurred during the study time period were also identified over the entire study period as well as 90 days and 2 years. Results: We identified 275,439 patients with femoral neck fractures who underwent HA and 26,017 patients who underwent THA, respectively. Patients undergoing HA had significantly lower rates ( p < 0.0001) of revision 2.48% versus 3.85% (OR = 0.633; 95% CI, 0.592–0.678), dislocation 1.76% versus 3.39% (0.512; 0.476–0.551), infection 3.44% versus 4.87% (0.694; 0.657–0.737). There was no statistical significant difference in 2-year cardiac morbidity ( p = 0.252). However, when controlling for age, patients 65–69 years showed no significant difference in infection or revision over the study period or at 2 years. Conclusions: In this study, patients who underwent THA for femoral neck fractures had a higher rate of dislocations, infections and increased rates of repeat surgery than those who underwent HA but this difference was not significant in patients 65–69 years. Hemiarthroplasty may result in fewer complications in older Medicare patients although this difference may not be present in younger Medicare patients.

scholarly journals An Analysis of the Relationship Between the Utilization of Physical Therapy Services and Outcomes of Care for Patients After Total Hip Arthroplasty

2000 ◽  
Vol 80 (5) ◽  
pp. 448-458 ◽  
Author(s):  
Janet K Freburger
Keyword(s):  
Physical Therapy ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Cost Of Care ◽  
Total Cost ◽  
Total Hip ◽  
Outcomes Of Care ◽  
The Relationship ◽  
Therapy Intervention ◽  
Physical Therapy Intervention

Abstract Background and Purpose. The effect of physical therapy intervention on the outcomes of care for patients treated in acute care hospitals has not been widely studied. This study examined the relationship between physical therapy utilization and outcomes of care for patients following total hip arthroplasty. Subjects. The sample consisted of 7,495 patients treated in US academic health center hospitals in 1996 who survived their inpatient stay and received physical therapy interventions. Methods. The primary data source was the University HealthSystem Consortium Clinical Data Base. Physical therapy use was assessed by examining physical therapy charges. Outcomes of care were assessed in terms of the total cost of care (ie, whether the care was more costly or less costly than expected, taking into account patient characteristics) and in terms of discharge destination (ie, whether the patient was discharged home or elsewhere). Regression analyses were conducted to examine the relationship between physical therapy use and outcomes. Results. Physical therapy intervention was directly related to a total cost of care that was less than expected and to an increased probability of discharge home. Conclusion and Discussion. The results of this study provide preliminary evidence to support the use of physical therapy intervention in the acute care of patients following total hip arthroplasty and indicate the need for further study of this topic.

scholarly journals Improving Prosthetic Selection and Predicting BMD from Biometric Measurements in Patients Receiving Total Hip Arthroplasty

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 815
Author(s):  
Carlo Ricciardi ◽  
Halldór Jónsson ◽  
Deborah Jacob ◽  
Giovanni Improta ◽  
Marco Recenti ◽  
...  
Keyword(s):  
Decision Making ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Quality Data ◽  
National Database ◽  
Patient Specific ◽  
Surgical Approaches ◽  
Decision Making Process ◽  
Mineral Density ◽  
Total Hip

There are two surgical approaches to performing total hip arthroplasty (THA): a cemented or uncemented type of prosthesis. The choice is usually based on the experience of the orthopaedic surgeon and on parameters such as the age and gender of the patient. Using machine learning (ML) techniques on quantitative biomechanical and bone quality data extracted from computed tomography, electromyography and gait analysis, the aim of this paper was, firstly, to help clinicians use patient-specific biomarkers from diagnostic exams in the prosthetic decision-making process. The second aim was to evaluate patient long-term outcomes by predicting the bone mineral density (BMD) of the proximal and distal parts of the femur using advanced image processing analysis techniques and ML. The ML analyses were performed on diagnostic patient data extracted from a national database of 51 THA patients using the Knime analytics platform. The classification analysis achieved 93% accuracy in choosing the type of prosthesis; the regression analysis on the BMD data showed a coefficient of determination of about 0.6. The start and stop of the electromyographic signals were identified as the best predictors. This study shows a patient-specific approach could be helpful in the decision-making process and provide clinicians with information regarding the follow up of patients.

scholarly journals Hepatitis E Virus Seroprevalence Among Liver Transplant Recipients with Persistent Elevation of Liver Enzymes: A Single Center Report

2021 ◽  
Vol 24 (1) ◽  
pp. 22-26
Author(s):  
Maryam Chorami ◽  
Kamran Bagheri Lankarani ◽  
Fardad Ejtehadi ◽  
Seyed Ali Malek-Hosseini ◽  
Maryam Moini
Keyword(s):  
Chronic Hepatitis ◽  
Liver Transplant ◽  
Hepatitis E Virus ◽  
Liver Enzymes ◽  
Organ Transplant ◽  
Hepatitis E ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Liver Transplant Recipients ◽  
Persistent Elevation

Background: Chronic hepatitis E infection has been reported in solid organ transplant recipients following acute hepatitis due to the compromised immune status. Almost all reports are from areas where hepatitis E virus (HEV) genotypes 3 and 4 are the dominant genotypes. This study was conducted to investigate the role of hepatitis E infection as an etiology for liver enzymes elevation in liver transplant recipients from the largest liver transplant program in Iran. Methods: In a prospective study from June to December 2015, in a single liver transplantation center in Iran, all adult liver recipients who were investigated for the etiology of persistent elevation of liver enzymes were tested for HEV serology status. Results: Of 122 patients included in the study, 19 (15.6%) were positive for HEV serology. Seropositive patients were significantly older than seronegative ones (mean age 43.79 vs. 31.58, P < 0.001); however, they were not different in other characteristics including sex distribution and mean of liver enzymes in each occasion. Liver biopsies were done in 16 HEV seropositive patients and none of the biopsies showed evidence for acute or chronic viral hepatitis. Conclusion: In this study, with 15.6% rate of HEV seropositivity in liver recipients with persistent elevation of liver enzymes, we were not able to confirm any clinical evidence for active acute or chronic hepatitis E infection. This could theoretically be attributed to the fact that the dominant prevalent HEV genotype in our endemic area is not associated with a chronic form of infection.

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