Dataset Information

Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database.

ABSTRACT:

Background

After release of the Comprehensive Care for Joint Replacement bundle, there has been increased emphasis on reducing readmission rates for total knee arthroplasty (TKA). The potential for a separate, clinically-relevant metric, TKA revision rates within a year following surgery, has not been fully explored. Based on this, we compared rates and payments for TKA readmission and revision procedures as metrics for improving quality and cost.

Methods

We utilized the 2013 Nationwide Readmission Database (NRD) to examine national readmission and revision rates, the reasons for revision procedures, and associated costs for elective TKA procedures. As data are not linked across years, we examined revision rates for TKA completed in the month of January by capturing revision procedures in the subsequent following 11-month period to approximate a 1-year revision rate. Diagnosis and procedure codes for revision procedures were collected. Average readmission and revision procedure costs were then calculated, and the cost distributed across the entire TKA population.

Results

We identified 20,851 patients having TKA surgery. The mean unadjusted 30- and 90-day TKA readmission rates were 3.4% and 5.8%, respectively. In contrast, the mean unadjusted 3-month and approximate 1-year reoperation rates were 1.0% and 1.6%, respectively. The most common cause for revision was periprosthetic joint infection, which accounting for 62% of all reported revision procedures. The mean payment for 90-day readmission was roughly half ($10,589±$11,084) of the mean inpatient payment for single reoperation procedure at 90 days ($20,222±$17,799). Importantly, nearly half (46%) of all 90-day readmissions were associated with a reoperation event within the first year.

Conclusions

Readmission following TKA is associated with a 1-year reoperation in approximately half of patients. These reoperations represent a significant patient burden and have a higher per episode cost. Early reoperation may represent a more clinically relevant target for quality improvement and cost containment.

SUBMITTER: Urish KL

PROVIDER: S-EPMC7327322 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Publications

Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database.

Urish Kenneth L KL Qin Yongmei Y Salka Bassel B Li Benjamin Y BY Borza Tudor T Sessine Michael M Kirk Peter P Hollenbeck Brent K BK Helm Jonathan E JE Lavieri Mariel S MS Skolarus Ted A TA Jacobs Bruce L BL

Annals of translational medicine 20200601 11

<h4>Background</h4>After release of the Comprehensive Care for Joint Replacement bundle, there has been increased emphasis on reducing readmission rates for total knee arthroplasty (TKA). The potential for a separate, clinically-relevant metric, TKA revision rates within a year following surgery, has not been fully explored. Based on this, we compared rates and payments for TKA readmission and revision procedures as metrics for improving quality and cost.<h4>Methods</h4>We utilized the 2013 Nati ...[more]

PMID: 32617307

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Project description:BACKGROUND:The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly. METHODS:This exploratory study investigated tissue-level cytokines in a cohort of patients (N?=?17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). The overall goal of this study was to provide insight into the localized cytokine response of tissues and identify tissue-level markers specific to inflammation caused by implants vs. inflammation caused by infection. Tissues were collected across several anatomical locations and assayed with a panel of 20 human inflammatory cytokines to understand spatial differences in cytokine levels. RESULTS:In this study, six cytokines were elevated in implanted joints, as compared to native joints: IL-10, IL-12p70, IL-13, IL-17A, IL-4, and TNF-? (p?<?0.05). Seven cytokines showed infection-dependent increases in localized tissues: IL-1?, IL-1?, IL-6, IL-8, MCP-1, MIP-1?, and MIP-1? (p?<?0.05). CONCLUSIONS:This study demonstrated that differences exist in tissue-level cytokines in response to presence of implant, and some cytokines were specifically elevated for infection; these responses may be informative of overall tissue health. These results highlight the utility of investigating localized cytokine concentrations to offer novel insights for total knee arthroplasty and total knee revision procedures, as well as their complications. Ultimately, this information could provide additional, quantitative measurements of tissue to aid clinical decision making and patient treatment options.

Project description:BackgroundTotal knee arthroplasty (TKA) is an effective treatment option for high body mass index (BMI) patients achieving similar outcomes to nonobese patients. However, increased rates of aseptic loosening in patients with a high BMI have been reported. Component fixation is a concern when performing TKA in the obese patient. To address this concern in cemented TKA, extended tibial stems have been used. Uncemented implants that take advantage of biologic osseointegration have also been advocated. This retrospective study examined the use of and revision rates of extended cemented tibial stems and uncemented implants compared with conventional cemented implants in our high BMI patient population.MethodsWe retrospectively reviewed a prospectively maintained database of 3239 primary Attune TKAs (Depuy, Warsaw, Indiana). All obese patients (BMI > 30 kg/m2) with > 30 months of follow-up were included in our analysis. Those who underwent cemented TKA using a tibial stem extension (Group 1) (n = 145) and those where cementless implants were used (Group 2) (n = 100) were compared to a control group (n = 1243) using a standard cemented implant. Primary outcome measures were all-cause revision, revision for aseptic loosening, and revision for tibial loosening. Kaplan-Meier survival analysis and Cox regression models were used to compare the primary outcomes between groups.ResultsIn total, there were 1512 knees that met the inclusion criteria. The mean follow-up was 6.8, 5.1, and 5.3 years for cemented, stemmed, and cementless groups, respectively. There were 37 all-cause revisions identified. Seven were for aseptic loosening (2 tibial, 1 femoral, and 4 involving both components); all of these were in the standard cemented implant group. There were no revisions in the stemmed or cementless implant groups. Survival analysis did not show any significant differences between groups for either all-cause revision or for aseptic loosening.ConclusionsThis retrospective analysis showed that there were no revisions required for aseptic loosening when a cemented, stemmed, or uncemented implant was used in obese patients. These findings show that cementless and extended stem implants are a reasonable option in obese patients.Level of evidenceLevel III.

Dataset Information

Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database.

Background

Methods

Results

Conclusions

Publications

Comparison of readmission and early revision rates as a quality metric in total knee arthroplasty using the Nationwide Readmission Database.

Similar Datasets

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