A Nationwide Analysis on the Impact of Schizophrenia Following Primary Total Knee Arthroplasty: A Matched-Control Analysis of 49,176 Medicare Patients |
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| Institution: | 1. Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, FL;2. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA;3. Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY;4. Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH;5. Department of Orthopaedic Surgery, University of Miami Hospital, Miami, FL;1. Department of Orthopaedic Surgery, CHU de Québec – Centre Hospitalier de l’Université Laval (CHUL), Québec City, Québec, Canada;2. Department of Orthopaedic Surgery, Hôtel-Dieu-de-Lévis, Lévis, Québec, Canada;3. Department of Surgery, Faculté de Médecine, Université Laval, Québec City, Québec, Canada;4. Department of Orthopaedic Surgery, CHU de Québec – Hôtel-Dieu-de-Québec, Québec, Québec, Canada;1. Division of Nephrology, Department of Medicine, Chang Gung Memorial Hospital, Putz City, Chiayi, Taiwan;2. Division of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan;3. School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan;4. Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Putz City, Chiayi, Taiwan;1. Arthritis and Total Joint Specialists, Northside Hospital Atlanta, Atlanta, GA;2. MABE Department, Center for Musculoskeletal Research, University of Tennessee, Knoxville, TN |
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| Abstract: | BackgroundThe influence of schizophrenia on total knee arthroplasty (TKA) is limited in the literature. Therefore, the purpose of this study was to investigate whether patients with schizophrenia undergoing primary TKA have (1) longer in-hospital length of stay (LOS); (2) higher readmission rates; (3) higher medical complications; (4) higher implant-related complications; and (5) higher costs of care compared to controls.MethodsPatients with schizophrenia undergoing primary TKA were identified within the Medicare claims database. The study group was randomly matched in a 1:5 ratio to controls according to age, sex, and medical comorbidities. The query yielded 49,176 patients with (n = 8,196) and without (n = 40,980) schizophrenia undergoing primary TKA. Primary outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, in addition to day of surgery and 90-day costs of care. A P-value less than .01 was considered statistically significant.ResultsSchizophrenia patients had longer in-hospital LOS (3.73 days vs 3.22 days, P < .0001) and had higher incidence and odds ratios (ORs) of readmission rates (18.26 vs 12.07%; OR: 1.58, P < .0001) compared to controls. Schizophrenia patients had higher incidence and odds of medical (3.23 vs 1.10%; OR: 2.99, P < .0001) and implant-related complications (5.92 vs 3.59%; OR: 1.68, P < .0001) and incurred significantly higher day of surgery ($13,300.58 vs $11,681.77, P < .0001) and 90-day costs of care ($18,222.18 vs $14,845.64, P < .0001).ConclusionThis study demonstrates that patients with schizophrenia have longer in-hospital LOS, higher readmission rates, higher complications, and increased costs of care after primary TKA. |
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| Keywords: | schizophrenia total knee arthroplasty complications medicare cost |
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