Use of Present-On-Admission Indicators for Complications After Total Knee Arthroplasty: An Analysis of Medicare Administrative Data

Administrative data are commonly used to evaluate total joint arthroplasty, but analyses have historically been limited by the inability to capture which conditions were present-on-admission (POA). In 2007 Medicare began allowing hospitals to submit POA information. We used Medicare Part A data from 2008 to 2009 to examine POA coding for three common complications (pulmonary embolism [PE], hemorrhage/hematoma, and infection) for primary and revision total knee arthroplasty (TKA). POA information was complete for 60%–75% of complications. There was no evidence that higher TKA volume hospitals or major teaching hospitals were more likely to accurately code POA data. The percentage of complications coded as POA ranged from 6.4% (PE during index admission for primary TKA) to 68.8% (infection during index admission for revision TKA). Early experience suggests that POA coding can significantly enhance the value of Medicare data for evaluating TKA outcomes.     

Relationship Between Original Renal Disease and Fate of Renal Allografts

This discussion summarizes current therapeutic thinking about some common skin diseases. Physicians disagree on the treatment of choice for some of these lesions but are in accord in treating others. Part 1 details diagnosis and treatment of acne vulgaris, psoriasis, pyoderma, fungous infections, candidiasis, eczemas, pruritus ani and pruritus vulvae, and contact dermatitis.     

The Management of Breech Presentation

The combination of prematurity and breech presentation subjects the fetus to great danger of death or birth trauma. Fetal mortality associated with breech presentation is 10 times higher when prematurity is added. Liberalization of indications for cesarean section is recommended as one way of improving fetal survival and lowering fetal morbidity associated with this abnormal fetal position.     

Facial Nerve Palsy

It is agreed that some cases of facial nerve palsy are surgical emergencies. Other cases are controversial. The best available electrodiagnostic test is 48 to 72 hours late in noting changes. An early test for axonotmesis is unavailable. Immediate consultation with a specialist qualified to deal with the problem is urged.