scholarly journals Outcomes and Resource Utilization in Calcium Pyrophosphate Deposition Disease Patients Who Underwent Total Knee Arthroplasty: A Retrospective Cohort Analysis.

2021 ◽  
Author(s):  
Konstantinos Parperis ◽  
Mohanad Hadi ◽  
Bikash Bhattarai
Keyword(s):  
Myocardial Infarction ◽  
Total Knee Arthroplasty ◽  
Hospital Mortality ◽  
Resource Utilization ◽  
Knee Arthroplasty ◽  
Calcium Pyrophosphate ◽  
Hospital Charges ◽  
Calcium Pyrophosphate Deposition Disease ◽  
Deposition Disease ◽  
Total Knee

Abstract Background: To evaluate the predictors, outcomes and resource utilization of total knee arthroplasty (TKA) in calcium pyrophosphate deposition disease (CPPD) patients. Methods: We used the US National Inpatient Sample database to identify CPPD and non-CPPD who underwent TKA from 2006 to 2014. Data collection included patient demographics and comorbidities. Outcomes following TKA included in-hospital mortality, complications, length of hospitalization, hospital charges, and disposition.Results: Among the 5,564,005 patients who have undergone TKA, 11529 (0.20%) had CPPD, with a median age of 72 years and 53.7% were females. Compared with non-CPPD, patients with CPPD were more likely to be older (mean: 72 vs 66 years; p<0.001), male, white, and have Medicare insurance. CPPD patients were more likely to have ≥ 2 comorbidities calculated by the Charlson comorbidity index and discharge to an inpatient/rehabilitation facility. Regarding inpatient complications, myocardial infarction and knee reoperation were significantly more common in CPPD patients. TKA in CPPD patients was associated with significantly higher odds of increased length of stay (>3 days) than those without CPPD (OR 1.43, 95% CI 1.37-1.49). There was no significant difference in the in-hospital mortality.Conclusions: CPPD patients who underwent TKA were more likely to have a longer hospital stay and discharge to a non-home setting than non-CPPD. Also, CPPD patients had a higher comorbidity burden, and greater risk for myocardial infarction and need for reoperation.

Resource utilization of total knee arthroplasty patients cared for on specialty orthopedic surgery units

2008 ◽  
Vol 3 (3) ◽  
pp. 218-227 ◽  
Author(s):  
John A. Batsis ◽  
James M. Naessens ◽  
Mark T. Keegan ◽  
Paul M. Huddleston ◽  
Amy E. Wagie ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Resource Utilization ◽  
Knee Arthroplasty ◽  
Orthopedic Surgery ◽  
Total Knee

scholarly journals Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

2020 ◽  
Author(s):  
Jian Wang ◽  
Qinfeng Yang ◽  
Yichuan Xu ◽  
Yuhang Chen ◽  
Qiang Lian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Total Knee Arthroplasty ◽  
Hospital Mortality ◽  
Knee Arthroplasty ◽  
Nationwide Inpatient Sample ◽  
Postoperative Delirium ◽  
Perioperative Complications ◽  
Total Knee ◽  
Total Charges

Abstract BackgroundPostoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after total knee arthroplasty (TKA) has not been well studied using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of insurance, in-hospital mortality, and medical and surgical perioperative complications were evaluated.ResultsA total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008. Patients with delirium after TKA presented more comorbidities, increased LOS, extra hospital charges, wider coverage of medicare, and higher in-hospital mortality (P<0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease and pulmonary circulation disorders, peripheral vascular disorders, renal failure, and teaching hospital. ConclusionsA relatively low incidence of delirium after TKA was identified. Postoperative delirium of TKA was associated with increased comorbidities, LOS, total charges, coverage of medicare, mortality and medical perioperative complications. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.

Resource evaluation framework for total knee arthroplasty

2020 ◽  
Vol 33 (2) ◽  
pp. 189-198
Author(s):  
Laura Ikuma ◽  
Isabelina Nahmens ◽  
Amani Ahmad ◽  
Yasaswi Gudipudi ◽  
Vinod Dasa
Keyword(s):  
Total Knee Arthroplasty ◽  
Resource Utilization ◽  
Knee Arthroplasty ◽  
Value Added ◽  
Healthcare Setting ◽  
Evaluation Framework ◽  
Industrial Engineering ◽  
Content Type ◽  
Work Sampling ◽  
Total Knee

PurposeThis article describes a framework for evaluating efficiency of OR procedures incorporating time measurement, personnel activity, and resource utilization using traditional industrial engineering tools of time study and work sampling.MethodsThe framework measures time using time studies of OR procedures and work sampling of personnel activities, ultimately classified as value-added or non-value-added. Statistical methods ensure that the collected samples meet adequate levels of confidence and accuracy. Resource utilization is captured through documentation of instrument trays used, defects in instruments, and trash weight and classification at the conclusion of surgeries.FindingsA case study comprising 12 observations of total knee arthroplasty surgeries illustrates the use of the framework. The framework allows researchers to compare time, personnel, and resource utilization simultaneously within the OR setting.Practical ImplicationsThe framework provides a holistic evaluation of methods, instrumentation and resources, and staffing levels and allows researchers to identify areas for efficiency improvement.Originality/valueThe methods presented in this article are rooted in traditional industrial engineering work measurement methods but are applied to a healthcare setting in order to efficiently identify areas for improvement including time, personnel, and processes in operating rooms.

Changes in Total Knee Arthroplasty Utilization since the Implementation of ACA: An Analysis of Patient–Hospital Demographics, Costs, and Charges

2019 ◽  
Vol 33 (07) ◽  
pp. 636-645
Author(s):  
Chukwuweike U. Gwam ◽  
Nequesha S. Mohamed ◽  
Jennifer I. Etcheson ◽  
Iciar M. Dávila Castrodad ◽  
Jaydev B. Mistry ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Low Income ◽  
Ordinal Data ◽  
Care Quality ◽  
Hospital Charges ◽  
Teaching Hospitals ◽  
Median Income ◽  
Urban Teaching ◽  
Total Knee

AbstractThe Patient Protection and Affordable Care Act (PPACA) formed the Center for Medicare and Medicaid Innovation Center which has implemented experimental reimbursement models targeted at high-demand procedures to improve care quality. However, the effect of health care reform on total knee arthroplasty (TKA) procedures has not been explored. This study explores patient–hospital level demographics, inpatient costs, and charges related to TKA procedures between 2009 and 2015. The National Inpatient Sample database was utilized to identify patients who received primary TKA between January 2009 and October 2015 (4,283,387 cases). Categorical, continuous, and ordinal data were analyzed using chi-square/Fisher's exact test, t-test/analysis of variance, or Kruskal–Wallis' test, respectively. There was an increase in proportion of TKA recipients belonging to minority groups and the lowest quartile of median income (p < 0.05). There was a 1.9% increase in recipients using Medicaid as a primary payor and volume shifts from urban nonteaching toward urban teaching hospitals. There was a reduction in mean length of stay and mean inpatient costs. There were increases in hospital charges, but reductions in rates of inpatient mortality, and other postoperative complications. TKA procedures remain the most common surgical procedure; therefore, our study assessed national trends to capture the effect of PPACA. We found an increasing proportion of TKA recipients belonging to minority and low-income groups, volume shifts to urban teaching hospitals, and lower costs of care. These findings may be useful in objectively critiquing the effects of PPACA on TKA-related care.

Hospital safety-net burden is associated with increased inpatient mortality after elective total knee arthroplasty: a retrospective multistate review, 2007–2018

2021 ◽  
pp. rapm-2020-101731
Author(s):  
Deirdre Clare Kelleher ◽  
Ryan Lippell ◽  
Briana Lui ◽  
Xiaoyue Ma ◽  
Tiffany Tedore ◽  
...  
Keyword(s):  
New York ◽  
Total Knee Arthroplasty ◽  
Hospital Mortality ◽  
Knee Arthroplasty ◽  
Intraoperative Complications ◽  
New York State ◽  
Safety Net ◽  
Hospital Safety ◽  
Increased Risk ◽  
Total Knee

BackgroundTotal knee arthroplasty (TKA) is among the most common surgical procedures performed in the USA and comprises an outsized proportion of Medicare expenditures. Previous work-associated higher safety-net burden hospitals with increased morbidity and in-hospital mortality following total hip arthroplasty. Here, we examine the association of safety-net burden on postoperative outcomes after TKA.MethodsWe retrospectively analyzed 1 141 587 patients aged ≥18 years undergoing isolated elective TKA using data from the State Inpatient Databases for Florida, Kentucky, Maryland, New York and Washington from 2007 through 2018. Hospitals were grouped into tertiles by safety-net burden status, defined by the proportion of inpatient cases billed to Medicaid or unpaid (low: 0%–16.83%, medium: 16.84%–30.45%, high: ≥30.45%). Using generalized estimating equation models, we assessed the association of hospital safety-net burden status on in-hospital mortality, patient complications and length of stay (LOS). We also analyzed outcomes by anesthesia type in New York State (NYS), the only state with this data.ResultsMost TKA procedures were performed at medium safety-net burden hospitals (n=6 16 915, 54%), while high-burden hospitals performed the fewest (n=2 04 784, 17.9%). Overall in-patient mortality was low (0.056%), however, patients undergoing TKA at medium-burden hospitals were 40% more likely to die when compared with patients at low-burden hospitals (low: 0.043% vs medium: 0.061%, adjusted OR (aOR): 1.40, 95% CI 1.09 to 1.79, p=0.008). Patients who underwent TKA at medium or high safety-net burden hospitals were more likely to experience intraoperative complications (low: 0.2% vs medium: 0.3%, aOR: 1.94, 95% CI 1.34 to 2.83, p<0.001; low: 0.2% vs high: 0.4%, aOR: 1.91, 95% CI 1.35 to 2.72, p<0.001). There were no statistically significant differences in other postoperative complications or LOS between the different safety-net levels. In NYS, TKA performed at high safety-net burden hospitals was more likely to use general rather than regional anesthesia (low: 26.7% vs high: 59.5%, aOR: 4.04, 95% CI 1.05 to 15.5, p=0.042).ConclusionsPatients undergoing TKA at higher safety-net burden hospitals are associated with higher odds of in-patient mortality than those at low safety-net burden hospitals. The source of this mortality differential is unknown but could be related to the increased risk of intraoperative complications at higher burden centers.

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