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Demographic, comorbidity, and episode of care trends in unicompartmental knee arthroplasty: 2008 to 2018

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study is to assess how unicompartmental knee arthroplasty (UKA) patient demographics, comorbidities, and episode of care outcomes have changed from 2008 to 2018 in order to better understand the impact of recent changes in healthcare ideology on UKA.

Methods

The National Surgical Quality Improvement Program was queried to identify demographics, comorbidities, and episode of care outcomes in patients undergoing primary UKA from 2008 to 2013 (n = 3096) vs 2014–2018 (n = 9073). Trends were analyzed using Student’s t-tests for continuous variables and Chi-squared tests and Fisher’s exact tests for categorical variables.

Results

When comparing the years 2008–2013 to 2014–2018, there was no clinically significant difference in age, body mass index (BMI), proportion of patients with a BMI > 40 kg/m2, percentage of diabetes (15.0% vs 15.5; p = 0.715), smoking status (10.2% vs 9.4%; 0.177), COPD (3.0% vs 2.8%; p = 0.645), CHF within 30 days (< 0.1% vs 0.2%; p = 0.060), or acute renal failure (0.0% vs < 0.1%; p = 0.621) in patients undergoing UKA. However, the rate of patients with dyspnea, (5.7% versus 3.6%; p < 0.001), anemia (9.4 versus 7.3%; p < 0.001), and overall morbidity/mortality probability have improved, with a decrease in hospital LOS (2.2 ± 1.9 days versus 1.4 ± 2.1 days; p < 0.001) and an increase in home-discharge (90.7% versus 95.2%; p < 0.001).

Conclusion

From 2008 to 2018, there was minimal improvement in UKA patients’ modifiable comorbidities. However, despite the lack of significant change in patient health status, our findings showed improvement in episode-of-care outcomes, implying that the value of UKA has been increasing over the last decade.

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References

  1. Porter ME (2010) What is value in health care? N Engl J Med 363:2477–2481. https://doi.org/10.1056/NEJMp1011024

    Article  CAS  PubMed  Google Scholar 

  2. Siddiqi A, White PB, Mistry JB et al (2017) Effect of bundled payments and health care reform as alternative payment models in total joint arthroplasty: a clinical review. J Arthroplasty 32:2590–2597

    Article  Google Scholar 

  3. Tyagi V, Farooq M (2017) Unicompartmental Knee Arthroplasty: Indications, outcomes, and complications. Conn Med 81:87–90

    PubMed  Google Scholar 

  4. Hansen EN, Ong KL, Lau E et al (2018) Unicondylar knee arthroplasty in the US patient population: prevalence and epidemiology. Am J Orthop. https://doi.org/10.12788/ajo.2018.0113

    Article  PubMed  Google Scholar 

  5. Bolognesi MP, Greiner MA, Attarian DE et al (2013) Unicompartmental knee arthroplasty and total knee arthroplasty among medicare beneficiaries, 2000 to 2009. J Bone Jt Surg Ser A. https://doi.org/10.2106/JBJS.L.00652

    Article  Google Scholar 

  6. Keswani A, Koenig KM, Torchia MT et al (2019) Designing and implementing value-based care delivery and payment models for musculoskeletal care. Instr Course Lect 68:651–658

    PubMed  Google Scholar 

  7. NSQIP (2018) American College of Surgeons National Surgical Quality Improvement Program

  8. Cohen ME, Ko CY, Bilimoria KY et al (2013) Optimizing ACS NSQIP modeling for evaluation of surgical quality and risk: patient risk adjustment, procedure mix adjustment, shrinkage adjustment, and surgical focus. J Am Coll Surg 217:336-346.e1. https://doi.org/10.1016/j.jamcollsurg.2013.02.027

    Article  PubMed  Google Scholar 

  9. Blanc B (1968) Nutritional anaemias. report of a WHO scientific group. WHO–Tech Rep Ser 405:1–40

    Google Scholar 

  10. Bharadwaj S, Ginoya S, Tandon P et al (2016) Malnutrition: Laboratory markers vs nutritional assessment. Gastroenterol Rep 4:270–280

    Google Scholar 

  11. Dieleman JL, Squires E, Bui AL et al (2017) Factors associated with increases in US health care spending, 1996–2013. JAMA - J Am Med Assoc 318:1668–1678. https://doi.org/10.1001/jama.2017.15927

    Article  Google Scholar 

  12. Squires DA (2011) The U.S. health system in perspective: a comparison of twelve industrialized nations. Issue Brief (Commonw Fund) 16:1–14

    Google Scholar 

  13. Chee TT, Ryan AM, Wasfy JH, Borden WB (2016) Current state of value-based purchasing programs. Circulation 133:2197–2205. https://doi.org/10.1161/CIRCULATIONAHA.115.010268

    Article  PubMed  PubMed Central  Google Scholar 

  14. Cizmic Z, Novikov D, Feng J et al (2019) Alternative payment models in total joint arthroplasty under the affordable care act. JBJS Rev 7:e4. https://doi.org/10.2106/JBJS.RVW.18.00061

    Article  PubMed  Google Scholar 

  15. Froemke CC, Wang L, DeHart ML et al (2015) Standardizing care and improving quality under a bundled payment initiative for total joint arthroplasty. J Arthroplasty 30:1676–1682. https://doi.org/10.1016/j.arth.2015.04.028

    Article  PubMed  Google Scholar 

  16. Iorio R, Clair AJ, Inneh IA et al (2016) Early results of medicare’s bundled payment initiative for a 90-day total joint arthroplasty episode of care. J Arthroplasty 31:343–350. https://doi.org/10.1016/j.arth.2015.09.004

    Article  PubMed  Google Scholar 

  17. Althausen PL, Mead L (2016) Bundled payments for care improvement: lessons learned in the first year. J Orthop Trauma 30:S50–S53. https://doi.org/10.1097/BOT.0000000000000715

    Article  PubMed  Google Scholar 

  18. Dundon JM, Bosco J, Slover J et al (2016) Improvement in total joint replacement quality metrics. J Bone Jt Surg–Am 98:1949–1953

    Article  Google Scholar 

  19. Healy WL, Ayers ME, Iorio R et al (1998) Impact of a clinical pathway and implant standardization on total hip arthroplasty: a clinical and economic study of short-term patient outcome. J Arthroplasty 13:266–276. https://doi.org/10.1016/S0883-5403(98)90171-1

    Article  CAS  PubMed  Google Scholar 

  20. Healy WL, Iorio R, Ko J et al (2002) Impact of cost reduction programs on short-term patient outcome and hospital cost of total knee arthroplasty. J Bone Jt Surg–Ser A 84:348–353. https://doi.org/10.2106/00004623-200203000-00003

    Article  Google Scholar 

  21. Dummit LA, Kahvecioglu D, Marrufo G et al (2016) Association between hospital participation in a medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA–J Am Med Assoc 316:1267–1278. https://doi.org/10.1001/jama.2016.12717

    Article  Google Scholar 

  22. Mor V, Intrator O, Feng Z, Grabowski DC (2010) The revolving door of rehospitalization from skilled nursing facilities. Health Aff 29:57–64. https://doi.org/10.1377/hlthaff.2009.0629

    Article  Google Scholar 

  23. Chandra A, Dalton MA, Holmes J (2013) Large increases in spending on postacute care in medicare point to the potential for cost savings in these settings. Health Aff 32:864–872. https://doi.org/10.1377/hlthaff.2012.1262

    Article  Google Scholar 

  24. Brander V, Gondek S, Martin E, Stulberg SD (2007) The John Insall award: pain and depression influence outcome years after knee replacement surgery. in clinical orthopaedics and related research. Lippincott Williams and Wilkins, Philadelphia

    Google Scholar 

  25. Blackburn J, Qureshi A, Amirfeyz R, Bannister G (2012) Does preoperative anxiety and depression predict satisfaction after total knee replacement? Knee 19:522–524. https://doi.org/10.1016/j.knee.2011.07.008

    Article  PubMed  Google Scholar 

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, 9501 Euclid Avenue, Cleveland, OH, 44106, USA

    Kara McConaghy

  2. Department of Orthopaedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA

    Jared A. Warren, Ahmed Siddiqi, Trevor Murray, Robert Molloy & Nicolas S. Piuzzi

Authors
  1. Kara McConaghy
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  2. Jared A. Warren
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  3. Ahmed Siddiqi
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  4. Trevor Murray
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  5. Robert Molloy
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  6. Nicolas S. Piuzzi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jared A. Warren and Ahmed Siddiqi. The first draft of the manuscript was written by Kara McConaghy and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nicolas S. Piuzzi.

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Conflict of interest

Kara McConaghy has no relevant financial or non-financial interests to disclose. Jared A. Warren has no relevant financial or non-financial interests to disclose. Ahmed Siddiqi is an unpaid consultant for AZ Solutions, LLC; stock options in ROMTech and paid consultant for Zimmer-Biomet; none of which are relevant for this manuscript. Trevor Murray is a board member of MAOA; board member of AAHKS; and is a paid consultant for Zimmer-Biomet; none of which are relevant for this manuscript. Robert Molloy is a paid consultant and receives research support from Stryker, research support from Zimmer-Biomet and is a board member for AAHKS; none of which are relevant for this manuscript. Nicolas S. Piuzzi is a board member of ISCT; governing board member of Journal of Knee Surgery, Journal of Hip Surgery and Orthopaedic Research Society. Dr. Piuzzi receives research support from RegenLab and Zimmer-Biomet; none of which are relevant for this manuscript.

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McConaghy, K., Warren, J.A., Siddiqi, A. et al. Demographic, comorbidity, and episode of care trends in unicompartmental knee arthroplasty: 2008 to 2018. Eur J Orthop Surg Traumatol 32, 121–128 (2022). https://doi.org/10.1007/s00590-021-02942-0

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  • DOI: https://doi.org/10.1007/s00590-021-02942-0

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