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1.
Brian M. Godshaw Ashley E. Mehl Jeffrey G. Shaffer Mark S. Meyer Leslie C. Thomas George F. Chimento 《The Journal of arthroplasty》2019,34(4):645-649
Background
Peri-operative dexamethasone has been shown to effectively reduce post-operative nausea and vomiting and aide in analgesia after total joint arthroplasty (TJA); however, systemic glucocorticoid therapy has many adverse effects. The purpose of this study is to determine the effects of dexamethasone on prosthetic joint infection (PJI) and blood glucose levels in patients undergoing TJA.Methods
A retrospective chart review of all patients receiving primary TJA from 2011 to 2015 (n = 2317) was conducted. Patients were divided into 2 cohorts: dexamethasone (n = 1426) and no dexamethasone (n = 891); these groups were subdivided into diabetic and non-diabetic patients. The primary outcome was PJI; secondary measures included glucose levels and pre-operative hemoglobin A1c (A1c) values. Statistics were carried out using logistic and regression models.Results
Of the 2317 joints, 1.12% developed PJI; this was not affected by dexamethasone (P = .166). Diabetics were found to have higher rate of infection (P < .001); however, diabetics who received dexamethasone were not found to have a significantly higher infection rate that non-diabetics (P = .646). Blood glucose levels were found to increase post-operatively, and dexamethasone did not increase this change (P = .537). Diabetes (P < .001) and increasing hemoglobin A1c (P < .001) were also associated with increased serum glucose levels; however, this was not influenced by dexamethasone (P = .595).Conclusion
Although diabetic patients were found to have a higher infection rate overall, this was not affected by administration of intravenous dexamethasone, nor was the post-operative elevation in serum glucose levels. In this study population, peri-operative intravenous dexamethasone did not increase the rate of PJI and was safe to administer in patients undergoing TJA. 相似文献2.
Joseph J. Kavolus Daniel J. Cunningham Sneha R. Rao Samuel S. Wellman Thorsten M. Seyler 《The Journal of arthroplasty》2019,34(4):710-716.e3
Background
Polymicrobial hip arthroplasty infections are a subset of periprosthetic joint infection (PJI) with distinct challenges representing 10%-47% of PJI.Methods
Records were reviewed from all PJIs involving partial or total hip arthroplasty with positive hip cultures between 2005 and 2015 in order to determine baseline characteristics and outcomes including treatment success, surgeries for infection, and days in hospital for infection. Analysis was restricted to patients who had at least 2 years of follow-up after their final surgery or hospitalization for infection. Factors with P-value less than .05 in univariate outcomes analysis were included in multivariable models.Results
After multivariable analysis, 28 of 95 hip arthroplasty PJIs which were polymicrobial were associated with significantly lower treatment success, more surgery, and longer hospitalizations compared to PJIs which were not polymicrobial. Patients diagnosed with polymicrobial infection later in treatment (4 of 28) had the lowest treatment success rate, underwent the most surgery, and spent the longest time in hospital.Conclusion
Polymicrobial periprosthetic hip infection is a particularly devastating complication of hip arthroplasty associated with decreased likelihood of treatment success, increased surgery for infection, and greater time in hospital. Patients with late polymicrobial infection had the worst outcomes. This investigation further characterizes the natural history of periprosthetic hip infections with more than one infectious organism. Patients who present with a subsequent polymicrobial infection should be educated that they have a particularly difficult treatment course and treatment success may not be possible. 相似文献3.
Antonia F. Chen Michael M. Kheir Joshua M. Greenbaum Camilo Restrepo Mitchell G. Maltenfort Javad Parvizi 《The Journal of arthroplasty》2017,32(7):2234-2238
Background
Periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) is a serious complication with multiple etiologies. Prior spine literature has shown that later cases in the day were more likely to develop surgical site infection. However, the effect of case order on PJI after TJA is unknown. This study aims to determine the influence of case order, prior infected case, and terminal cleaning on the risk for a subsequent PJI.Methods
A retrospective, single-institution study was conducted on 31,499 TJAs performed from 2000 to 2014. Case order was determined by case start times per date within the same operating room. PJI was defined by the Musculoskeletal Infection Society criteria. Logistic regression was used to determine risk factors for a subsequent PJI.Results
Noninfected cases followed an infected case in 92 of 31,499 cases (0.29%) and were more likely to develop PJI (adjusted odds ratio [OR], 2.43; P = .029). However, terminal cleaning after infected cases did not affect the risk for PJI in cases the following morning (OR, 1.42; P = .066). Case order had an OR of 0.98 (P = .655), implying that later cases did not have a higher likelihood of infection.Conclusion
Although surgical case order is not an independent risk factor for subsequent PJI, TJA cases following an infected case in the same room on the same day have a higher infection risk. Despite improved sterile technique and clean air operating rooms, the risk of contaminating a TJA with pathogens from a prior infected case appears to be high. Terminal cleaning appears to be effective in reducing the bioburden in the operating room. 相似文献4.
Kyle R. Duchman Andrew J. Pugely Christopher T. Martin Yubo Gao Nicholas A. Bedard John J. Callaghan 《The Journal of arthroplasty》2017,32(4):1285-1291
Background
Increased operative time has been associated with increased complications after total joint arthroplasty (TJA). The purpose of the present study was to investigate the effect of operative time on short-term complications after TJA while also identifying patient and operative factors associated with prolonged operative times.Methods
The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011-2013 to identify all patients who underwent primary total hip or knee arthroplasty. Patients were stratified by operative time, and 30-day morbidity and mortality data compared using univariate and multivariable analyses.Results
We identified 99,444 patients who underwent primary TJA. The overall incidence of complications after TJA was 4.9%. Overall complications were increased in patients with operative times >120 minutes (5.9%) as compared to patients with operative times <60 minutes or 60-120 minutes (4.6% and 4.8%, respectively; P < .001). Wound complications, including surgical site infection, were also increased for procedures lasting >120 minutes. In a multivariable analysis, operative time exceeding 120 minutes remained an independent predictor of any complication and wound complication, with each 30-minute increase in operative time beyond 120 minutes further increasing risk. Patient age ≤65 years, male sex, black race, body mass index ≥30 kg/m2, and an American Society of Anesthesiologists classification of 3 or 4, predicted operative times >120 minutes.Conclusion
We found that operative time >120 minutes was associated with increased short-term morbidity and mortality after primary TJA. Younger age, male sex, black race, obesity, and increased comorbidity were risk factors for operative time exceeding 120 minutes. 相似文献5.
Daniel E. Goltz Sean P. Ryan Claire B. Howell David Attarian Michael P. Bolognesi Thorsten M. Seyler 《The Journal of arthroplasty》2019,34(5):857-864
Background
Evolving reimbursement models increasingly compel hospitals to assume costs for 90-day readmission after total joint arthroplasty. Although risk assessment tools exist, none currently reach the predictive performance required to accurately identify high-risk patients and modulate perioperative care accordingly. Although unlikely to perform adequately alone, the Elixhauser index is a set of 31 variables that may lend value in a broader model predicting 90-day readmission.Methods
Elixhauser comorbidities were examined in 10,022 primary unilateral total joint replacements, of which 4535 were hip replacements and 5487 were knee replacements, all performed between June 2013 and January 2018 at a single tertiary referral center. Data were extracted from electronic medical records using structured query language. After randomizing to derivation (80%) and validation (20%) subgroups, predictive models for 90-day readmission were generated and transformed into a system of weights based on each parameter’s relative performance.Results
We observed 497 90-day readmissions (5.0%) during the study period, which demonstrated independent associations with 14 of the 31 Elixhauser comorbidity groups. A score created from the sum of each patient’s weighted comorbidities did not lose substantial predictive discrimination (area under the curve: 0.653) compared to a comprehensive multivariable model containing all 31 unweighted Elixhauser parameters (area under the curve: 0.665). Readmission risk ranged from 3% for patients with a score of 0 to 27% for those with a score of 8 or higher.Conclusions
The Elixhauser comorbidity score already meets or exceeds the predictive discrimination of available risk calculators. Although insufficient by itself, this score represents a valuable summary of patient comorbidities and merits inclusion in any broader model predicting 90-day readmission risk after total joint arthroplasty.Level of Evidence
III. 相似文献6.
Rushabh M. Vakharia Wayne B. Cohen-Levy Ajit M. Vakharia Chester J. Donnally Tsun Yee Law Martin W. Roche 《The Journal of arthroplasty》2019,34(5):959-964.e1
Background
Sleep apnea (SA) negatively affects bone mineralization, cognition, and immunity. There is paucity in the literature regarding the impact of SA on total joint arthroplasty (TJA). The purpose of this study is to compare complications in patients with and without SA undergoing either total knee (TKA) or total hip arthroplasty (THA).Methods
A retrospective review from 2005 to 2014 was conducted using the Medicare Standard Analytical Files. Patients with and without SA on the day of the primary TJA were queried using the International Classification of Diseases, ninth revision codes. Patients were matched by age, gender, Charlson Comorbidity Index), and body mass index. Patients were followed for 2 years after their surgery. Ninety-day medical complications, complications related to implant, readmission rates, length of stay, and 1-year mortality were quantified and compared. Logistic regression was used to calculate odds ratios (OR) with their respective 95% confidence interval and P values.Results
After the random matching process there were 529,240 patients (female = 271,656, male = 252,106, unknown = 5478) with (TKA = 189,968, THA = 74,652) and without (TKA = 189,968, THA = 74,652) SA who underwent primary TJA between 2005 and 2014. Patients with SA had greater odds of developing medical complications following TKA (OR 3.71) or THA (OR 2.48).Conclusion
The study illustrates an increased risk of developing postoperative complications in patients with SA following primary TJA. Surgeons should educate patients on these adverse effects and encourage the use of continuous positive airway pressure which has been shown to mitigate many postoperative complications. 相似文献7.
Background
Smoking is associated with adverse outcomes after total joint arthroplasty (TJA), including periprosthetic joint infection (PJI). Although preoperative smoking cessation interventions may help reduce the risk PJI, the short-term cost-effectiveness of these programs remains unclear.Methods
Decision analysis was used to evaluate the cost-effectiveness of a preoperative smoking cessation intervention over a 90-day TJA episode of care. Costs and probabilities were derived from literature review and published Medicare data. Thresholds for cost and efficacy of the intervention were determined using sensitivity analysis.Results
In our model, the average 90-day cost was $32 less for patients enrolled in a mandatory smoking cessation intervention ($23,457) compared with patients who were not ($23,489). In sensitivity analyses, the smoking cessation intervention was cost-saving vs no intervention when the short-term cost of PJI was greater than $95,410, the rate of PJI was reduced by at least 25% for former vs current smokers, the cost of the intervention was less than $219, or the success rate of the intervention was greater than 56%.Conclusion
Smoking cessation interventions prior to TJA can increase the value of care and are an important public health initiative. Routine referral to smoking cessation interventions should be considered for smokers indicated for TJA.Level of Evidence
Level II, economic and decision analyses. 相似文献8.
Serene Z. Mirza Shawn S. Richardson Cynthia A. Kahlenberg Jason L. Blevins Charles Lautenbach Michelle Demetres Lily Martin Jackie Szymonifka Peter K. Sculco Mark P. Figgie Susan M. Goodman 《The Journal of arthroplasty》2019,34(5):1032-1036.e2
Background
Patients with inflammatory arthritis (IA) are at increased risk of prosthetic joint infections (PJI), yet differentiating between septic and aseptic failure is a challenge. The aim of our systematic review is to evaluate synovial biomarkers and their efficacy at diagnosing PJI in patients with IA.Methods
A comprehensive literature search was performed in the following databases from inception to January 2018: Ovid MEDLINE, Ovid EMBASE, and the Cochrane Library. Searches across the databases retrieved 367 results. Two of 5 reviewers independently screened a total of 298 citations. Discrepancies were resolved by a third reviewer. Twenty articles fit our criteria, but due to methodological differences findings could not be pooled for meta-analysis. For 5 studies, raw data were provided, pooled, and used to derive optimal diagnostic cut points.Results
Our final analysis included 1861 non-IA patients, including 426 patients with PJI, and 90 IA patients of whom 26 had PJI. There was a significant difference among the 4 groups for serum C-reactive protein (CRP), erythrocyte sedimentation rate, and synovial CRP, polymorphonuclear neutrophil percent, white blood cells, interleukin (IL)-6, IL-8, and IL-1b. Polymorphonuclear neutrophil percent had the highest sensitivity (95.2%) and specificity (85.0%) to detect infections with an optimum threshold of 78%.Conclusion
While levels of synovial white blood cells, IL-6, IL-8, and serum CRP appear higher in patients with IA, there is overlap with those who are not infected. Further studies are needed to explore diagnostic tests that will better detect PJI in patients with IA. 相似文献9.
Jeffrey B. Stambough Denis Nam David K. Warren James A. Keeney John C. Clohisy Robert L. Barrack Ryan M. Nunley 《The Journal of arthroplasty》2017,32(3):728-734.e1
Background
Staphylococcus aureus colonization has been identified as a key modifiable risk factor in the reduction of surgical site infections (SSI) related to elective total joint arthroplasty (TJA). We investigated the incidence of SSIs and cost-effectiveness of a universal decolonization protocol without screening consisting of nasal mupirocin and chlorhexidine before elective TJA compared to a program in which all subjects were screened for S aureus and selectively treated if positive.Methods
We reviewed 4186 primary TJAs from March 2011 through July 2015. Patients were divided into 2 cohorts based on the decolonization regimen used. Before May 2013, 1981 TJA patients were treated under a “screen and treat” program while the subsequent 2205 patients were treated under the universal protocol. We excluded the 3 months around the transition to control for treatment bias. Outcomes of interest included SSI and total hospital costs.Results
With a universal decolonization protocol, there was a significant decrease in both the overall SSI rate (5 vs 15 cases; 0.2% vs 0.8%; P = .013) and SSIs caused by S aureus organisms (2 vs 10; 0.09% vs 0.5%; P = .01). A cost analysis accounting for the cost to administer the universal regimen demonstrated an actual savings of $717,205.59. TJA complicated by SSI costs 4.6× more to treat than that of an uncomplicated primary TJA.Conclusion
Our universal decolonization paradigm for elective TJA is effective in reducing the overall rate of SSIs and promoting economic gains for the health system related to the downstream savings accrued from limiting future reoperations and hospitalizations. 相似文献10.
Alisina Shahi Timothy L. Tan Antonia F. Chen Mitchell G. Maltenfort Javad Parvizi 《The Journal of arthroplasty》2017,32(3):948-952.e1
Background
While periprosthetic joint infection (PJI) has a huge impact on patient function and health, only a few studies have investigated its impact on mortality. The purpose of this large-scale study was to (1) determine the rate and trends of in-hospital mortality for PJI and (2) compare the in-hospital mortality rate of patients with PJI and those undergoing revision arthroplasty for aseptic failure and patients undergoing other nonorthopedic major surgical procedures.Methods
Data from the Nationwide Inpatient Sample from 2002 to 2010 were analyzed to determine the risk of in-hospital mortality for PJI patients compared with aseptic revision arthroplasty. The Elixhauser comorbidity index was used to obtain patient comorbidities. Multiple logistic regression analyses were used to examine whether PJI and other patient-related factors were associated with mortality.Results
PJI was associated with an increased risk (odds ratio, 2.05; P < .0001) of in-hospital mortality (0.77%) compared with aseptic revisions (0.38%). The in-hospital mortality rate of revision total hip arthroplasties with PJI was higher than those for interventional coronary procedures (1.22%; 95% confidence interval [CI], 1.20-1.24), cholecystectomy (1.13%; 95% CI, 1.11-1.15), kidney transplant (0.70%; 95% CI, 0.61-0.79), and carotid surgery (0.89%; 95% CI, 0.86-0.93).Conclusion
Patients undergoing treatment for PJI have a 2-fold increase in in-hospital mortality for each surgical admission compared to aseptic revisions. Considering that PJI cases often have multiple admissions and that this analysis is by surgical admission, the risk of mortality will accumulate for every additional surgery. Surgeons should be cognizant of the potentially fatal outcome of PJI and the importance of infection control to reduce the risk of mortality. 相似文献11.
Lewis Moss Ran Schwarzkopf Jonathan Vigdorchik Richard Iorio William J. Long 《The Journal of arthroplasty》2019,34(5):1003-1007.e3
Background
As the clinical and financial environments of total joint arthroplasty (TJA) have evolved over the last several decades so has the role of the surgeon in providing this care to patients. Our objective was to examine current practices and influential factors among fellowship-trained arthroplasty surgeons.Methods
An electronic survey was sent to all surgeons who had completed one of the three high-volume adult reconstruction fellowships from the years 2007-2016. The survey consisted of 34 questions regarding current practice characteristics, case volumes for primary and revision total hip arthroplasty (THA) and total knee arthroplasty (TKA), use of advanced technologies, choice of surgical approach and implant design, factors influencing their choices, and their involvement in implant selection and contract negotiations.Results
Questionnaires were sent to 53 surgeons; 52 were completed. Sixty percent of respondents performed at least 100 TKAs and 84% performed at least 50 THAs annually. Ninety-four percent use a single company’s implant for more than 90% of primary TKA and THA. Fellowship or residency experience was the most significant influence on TKA and THA implant selection for 62% and 45% of surgeons, respectively, while contracts of their current institution were the primary influence for 17% and 12%, respectively. Fifty-five percent of surgeons used some advanced technology of which 16% said this influenced their implant choice. Eighty-six percent perform the majority of cases at centers performing at least 200 TJAs per year, and 39% participate in implant contract negotiations.Conclusion
Despite changes in the economic environment of TJA, this study demonstrates that experience with a specific implant during training, particularly fellowship, is the most influential factor for implant selection among fellowship-trained arthroplasty surgeons. 相似文献12.
Christopher J. Dy Derek S. Brown Hera Maryam Matthew R. Keller Margaret A. Olsen 《The Journal of arthroplasty》2019,34(4):619-625.e1
Background
Although Medicaid expansion has improved access to primary care services, its impact on surgical specialty utilization remains unclear. The aim of this study is to determine whether Medicaid expansion is associated with increased utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid).Methods
Using administrative data sources, we analyzed 374,877 total hospitalizations (236,333 in Illinois and 138,544 in Missouri) for THA/TKA from 2011 to 2016 (Illinois’ Medicaid expansion date: January 1, 2014).Results
The percentage of THA/TKA funded by Medicaid in Illinois was 2.4% in 2013 and 3.9% in 2016 (Missouri 2013: 2.7%; 2016: 2.6%). A difference-in-difference analysis (adjusted for patient age and gender, county-level Area Deprivation Index, and number of orthopedic surgeons) demonstrated a statistically significant increase in Medicaid-funded THA/TKA in Illinois in 2016 compared to 2013 (P = .012).Conclusion
Our study demonstrates that Medicaid expansion in Illinois was associated with increased utilization of THA and TKA. Further study is needed to understand the impact of Medicaid expansion in other states and for other procedures. 相似文献13.
James A. Keeney James L. Cook Stacee W. Clawson Ajay Aggarwal James P. Stannard 《The Journal of arthroplasty》2019,34(4):723-728
Background
The potential value of incisional negative pressure wound therapy (iNPWT) on lower extremity total joint arthroplasty (TJA) wound healing has been supported in a few retrospective studies. We performed this prospective, randomized, controlled trial to assess the impact of iNPWT on wound appearance, early complications, and late infection rates following hip and knee TJA compared with a standard surgical dressing.Methods
Three-hundred ninety-eight patients undergoing primary or revision lower extremity TJA were randomized into iNPWT or conventional wound dressing groups. Wound healing and early complication rates were assessed at 7, 14, and 35 days after the index surgery. Late infection rates were determined at a mean 2-year follow-up.Results
Patients treated with an iNPWT device were more likely to report wound drainage at day 7 (P = .01), but less drainage longer than 14 days (P = .04). Wound drainage was significantly higher for total hip arthroplasty patients at day 7 (P = .04), but differences were not sustained through the other time intervals. Total knee arthroplasty patients with a body mass index > 35 kg/m2 treated with an iNPWT device experienced fewer complications (1.3% vs 21.6%, P < .01) and fewer dressing-related concerns (1.3% vs 10.8%, P = .02) compared with a conventional dressing. No significant difference in late superficial or deep infection rates was identified between iNPWT and conventional dressing groups (4.0% vs 3.4%, P = .8).Conclusion
Our study findings support improved soft tissue healing response with the use of iNPWT devices. While postoperative wound drainage may limit their value following total hip arthroplasty, incisional NPWT devices may have a targeted benefit for elective total knee arthroplasty patients with a body mass index > 35 kg/m2. Specific study in this higher-risk patient group may be helpful to define the value of iNPWT. 相似文献14.
Matthew W. Bullock Matthew L. Brown Daniel N. Bracey Maxwell K. Langfitt John S. Shields Jason E. Lang 《The Journal of arthroplasty》2017,32(4):1067-1073
Background
Periprosthetic joint infection (PJI) represents a devastating complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Modifiable patient risk factors as well as various intraoperative and postoperative variables have been associated with risk of PJI. In 2011, our institution formulated a “bundle” to optimize patient outcomes after THA and TKA. The purpose of this report is to describe the “bundle” protocol we implemented for primary THA and TKA patients and to analyze its impact on rates of PJI and readmission.Methods
Our bundle protocol for primary THA and TKA patients is conceptually organized about 3 chronological periods of patient care: preoperative, intraoperative, and postoperative. The institutional total joint database and electronic medical record were reviewed to identify all primary THAs and TKAs performed in the 2 years before and following implementation of the bundle. Rates of PJI and readmission were then calculated.Results
Thirteen of 908 (1.43%) TKAs performed before the bundle became infected compared to only 1 of 890 (0.11%) TKAs performed after bundle implementation (P = .0016). Ten of 641 (1.56%) THAs performed before the bundle became infected, which was not statistically different from the 4 of 675 (0.59%) THAs performed after the bundle that became infected (P = .09).Conclusion
The bundle protocol we describe significantly reduced PJIs at our institution, which we attribute to patient selection, optimization of modifiable risk factors, and our perioperative protocol. We believe the bundle concept represents a systematic way to improve patient outcomes and increase value in total joint arthroplasty. 相似文献15.
Gannon L. Curtis Mhamad Faour Jaiben George Alison K. Klika Wael K. Barsoum Carlos A. Higuera 《The Journal of arthroplasty》2018,33(6):1868-1871
Background
Studies have suggested that forced-air warmers (FAWs) increase contamination of the surgical site. In response, FAWs with high efficiency particulate air filters (FAW-HEPA) were introduced. This study compared infection rates following primary total joint arthroplasty (TJA) using FAW and FAW-HEPA.Methods
Primary TJA patients at a single healthcare system were retrospectively reviewed. A total of 5405 THA (n = 2419) and TKA (n = 2986) consecutive cases in 2013 and 2015 were identified. Patients in 2013 (n = 2792) had procedures using FAW, while FAW-HEPA was used in 2015 (n = 2613). The primary outcome was overall infection rate within 90-days. Sub-categorization of infections as periprosthetic joint infection (PJI) or surgical site infection (SSI) was also conducted. PJI was defined as reoperation with arthrotomy or meeting Musculoskeletal Infection Society (MSIS) criteria. SSI was defined as wound complications requiring antibiotics or irrigation/debridement.Results
The FAW and FAW-HEPA groups had similar rates of overall infection (1.65% [n = 46] vs 1.61% [n = 42], P > .99), SSI (1.18% [n = 33] vs 0.84% [n = 22], P = .27), and PJI (0.47% [n = 13] vs 0.77% [n = 20], P = .22). Regression models did not show FAW to be an independent risk factor for increased overall infection (odds ratio [OR] 1.00, 95% confidence interval [CI] 0.65-1.57, P = .97), SSI (OR 1.47, 95% CI 0.83-2.58, P = .18), or PJI (OR 0.53, 95% CI 0.25-1.13, P = .09).Conclusion
FAW were not correlated with a higher risk of overall infection, SSI, or PJI during TJA when compared to FAW-HEPA devices. 相似文献16.
17.
Andrea H. Stone James H. MacDonald Maulik S. Joshi Paul J. King 《The Journal of arthroplasty》2019,34(4):656-662
Background
Racial disparities in healthcare utilization and outcomes have been reported and have wide-reaching implications for individual patient and healthcare system; as providers we bear an ethical burden to address this disparity and provide culturally competent care. This study will examine the influence of race on length of stay, discharge disposition, and complications requiring reoperation following total joint arthroplasty (TJA).Methods
Single institution retrospective analysis of a consecutive series of 7208 primary TJA procedures performed between July 2013 and June 2017 was conducted. Chi-squared and t-tests were used to quantify differences between the groups and multiple logistic regression was used to identify race as an independent risk factor.Results
In total, 6182 (84.3%) white and 1026 (14.0%) African American (AA) patients were included. AA patients were younger (63.62 vs 66.84 years, P < .001), more likely female (68.8% vs 57.0%, P < .001), had a longer length of stay (2.19 vs 2.00 days, P < .001), more likely to experience septic complications (1.3% vs 0.5%, P = .002) and manipulation under anesthesia (3.9% vs 1.8%, P < .001), and less likely to discharge home (67.1% vs 81.1%, P < .001). Multiple logistic regression showed that AA patients were more likely to discharge to a facility (adjusted odds ratio 2.63, 95% confidence interval 2.19-3.16, P < .001) and experience a manipulation under anesthesia (adjusted odds ratio 1.90, 95% confidence interval 1.26-2.85, P = .002).Conclusion
AA patients undergoing TJA were younger with longer length of stay and a higher rate of nonhome discharge; AA race was identified as an independent risk factor. Further study is required to understand the differences identified in this study. Targeted interventions should be developed to attempt to eliminate the disparity. 相似文献18.
Daniel J. Snyder Thomas R. Kroshus Aakash Keswani Evan B. Garden Karl M. Koenig Kevin J. Bozic David S. Jevsevar Jashvant Poeran Calin S. Moucha 《The Journal of arthroplasty》2019,34(4):613-618
Background
Nursing Home Compare (NHC) ratings, created and maintained by Medicare, are used by both hospitals and consumers to aid in the skilled nursing facility (SNF) selection process. To date, no studies have linked NHC ratings to actual episode-based outcomes. The purpose of this study was to evaluate whether NHC ratings are valid predictors of 90-day complications, readmission, and bundle costs for patients discharged to an SNF after primary total joint arthroplasty (TJA).Methods
All SNF-discharged primary TJA cases in 2017 at a multihospital academic health system were queried. Demographic, psychosocial, and clinical variables were manually extracted from the health record. Medicare NHC ratings were then collected for each SNF. For patients in the Medicare bundle, postacute and total bundle cost was extracted from claims.Results
Four hundred eighty-eight patients were discharged to a total of 105 unique SNFs. In multivariate analysis, overall NHC rating was not predictive of 90-day readmission/major complications, >75th percentile postacute cost, or 90-day bundle cost exceeding the target price. SNF health inspection and quality measure ratings were also not predictive of 90-day readmission/major complications or bundle performance. A higher SNF staffing rating was independently associated with a decreased odds for >75th percentile 90-day postacute spend (odds ratio, 0.58; P = .01) and a 90-day bundle cost exceeding the target price (odds ratio = 0.69; P = .02) but was similarly not predictive of 90-day readmission/complications.Conclusion
Results of our study suggest that Medicare's NHC tool is not a useful predictor of 90-day costs, complications, or readmissions for SNFs within our health system. 相似文献19.
Nicholas A. Bedard David E. DeMik Jessell M. Owens Natalie A. Glass Jennifer DeBerg John J. Callaghan 《The Journal of arthroplasty》2019,34(2):385-396.e4
Background
The purpose of this study was to perform a systematic review and meta-analysis to quantitatively assess the association between tobacco use and the risk of any wound complication and periprosthetic joint infection (PJI) after primary total hip and total knee arthroplasty procedures.Methods
Relevant articles published before January 2018 were identified by systematically searching PubMed, EMBASE, and Cochrane library databases. Pooled odds ratios (OR) and 95% confidence intervals were calculated for end points of any wound complication and PJI. Additional analyses were performed to evaluate risks between current, former, and non–tobacco users.Results
Fourteen studies were included in the meta-analysis. Tobacco users had a significantly higher risk of wound complications (OR, 1.78 [1.32-2.39]) and PJI (OR, 2.02 [1.47-2.77]) compared to non–tobacco users. Compared to non–tobacco users, there was an increased risk of PJI among current (OR, 2.16 [1.57-2.97] and former (OR, 1.52 [1.16-1.99]) tobacco users. Current tobacco users also had a significantly increased risk of PJI compared to former tobacco users (OR, 1.52 [1.07-2.14]).Conclusion
Tobacco use before total hip and total knee arthroplasty significantly increases the risk of wound complications and PJI. This increased risk is present for both current and former tobacco users. However, former tobacco users had a significantly lower risk of wound complications and PJI compared to current tobacco users, suggesting that cessation of tobacco use before TJA can help to mitigate these observed risks. 相似文献20.
Sreeram Penna Kerri L. Bell Feng-Chih Kuo Robert Andrew Henderson Carol Foltz Antonia F. Chen 《The Journal of arthroplasty》2019,34(5):834-838