Skip to main content
SpringerLink
Log in

Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA

  • Symposium: Papers Presented at the Annual Meetings of The Knee Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The impact of specific baseline comorbid conditions on the relative risk of postoperative mortality and periprosthetic joint infection (PJI) in elderly patients undergoing TKA has not been well defined.

Questions/purposes

We calculated the relative risk of postoperative mortality and PJI associated with 29 comorbid conditions in Medicare patients undergoing TKA.

Patients and Methods

The Medicare 5% sample was used to calculate the relative risk of 90-day postoperative mortality and PJI as a function of 29 preexisting comorbid conditions in 83,011 patients who underwent primary TKA between 1998 and 2007.

Results

The independent risk factors for 90-day postoperative mortality (in decreasing order of significance) were congestive heart failure, metastatic cancer, renal disease, peripheral vascular disease, cerebrovascular disease, lymphoma, cardiac arrhythmia, dementia, pulmonary circulation disorders, and chronic liver disease. The independent risk factors for PJI (in decreasing order of significance) were congestive heart failure, chronic pulmonary disease, preoperative anemia, diabetes, depression, renal disease, pulmonary circulation disorders, obesity, rheumatologic disease, psychoses, metastatic tumor, peripheral vascular disease, and valvular disease.

Conclusions

We believe this information important when counseling elderly patients regarding the risks of mortality and PJI after TKA and risk-adjusting publicly reported TKA patient outcomes.

Level of Evidence

Level II, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Society of Anesthesiologists. ASA Physical Status Classification System. 2010. Available at: http://www.asahq.org/clinical/physicalstatus.htm. Accessed June 25, 2010.

  2. Borghi B, Casati A. Incidence and risk factors for allogenic blood transfusion during major joint replacement using an integrated autotransfusion regimen. The Rizzoli Study Group on Orthopaedic Anaesthesia. Eur J Anaesthesiol. 2000;17:411–417.

    PubMed  CAS  Google Scholar 

  3. Bozic KJ, Chiu VW, Takemoto SK, Greenbaum JN, Smith TM, Jerabek SA, Berry DJ. The validity of using administrative claims data in total joint arthroplasty outcomes research. J Arthroplasty. 2010;25:58–61.

    Article  PubMed  Google Scholar 

  4. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.

    Article  PubMed  CAS  Google Scholar 

  5. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36:8–27.

    Article  PubMed  CAS  Google Scholar 

  6. Gill GS, Mills D, Joshi AB. Mortality following primary total knee arthroplasty. J Bone Joint Surg Am. 2003;85:432–435.

    PubMed  Google Scholar 

  7. Jones CA, Voaklander DC, Johnston DW, Suarez-Almazor ME. The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Arch Intern Med. 2001;161:454–460.

    Article  PubMed  CAS  Google Scholar 

  8. Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010;468:52–56.

    Article  PubMed  Google Scholar 

  9. Lai K, Bohm ER, Burnell C, Hedden DR. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty. 2007;22:651–656.

    Article  PubMed  Google Scholar 

  10. Lavernia CJ, Laoruengthana A, Contreras JS, Rossi MD. All-Patient Refined Diagnosis-Related Groups in primary arthroplasty. J Arthroplasty. 2009;24:19–23.

    Article  PubMed  Google Scholar 

  11. Lee J, Singletary R, Schmader K, Anderson DJ, Bolognesi M, Kaye KS. Surgical site infection in the elderly following orthopaedic surgery. Risk factors and outcomes. J Bone Joint Surg Am. 2006;88:1705–1712.

    Article  PubMed  Google Scholar 

  12. Losina E, Barrett J, Baron JA, Katz JN. Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement recipients. J Clin Epidemiol. 2003;56:515–519.

    Article  PubMed  Google Scholar 

  13. Marchant MH Jr, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009;91:1621–1629.

    Article  PubMed  Google Scholar 

  14. Marik PE. The hazards of blood transfusion. Br J Hosp Med (Lond). 2009;70:12–15.

    Google Scholar 

  15. Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24:105–109.

    Article  PubMed  Google Scholar 

  16. Parvizi J, Sullivan TA, Trousdale RT, Lewallen DG. Thirty-day mortality after total knee arthroplasty. J Bone Joint Surg Am. 2001;83:1157–1161.

    PubMed  Google Scholar 

  17. Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–1715.

    Article  PubMed  Google Scholar 

  18. Thillemann TM, Pedersen AB, Mehnert F, Johnsen SP, Soballe K. The risk of revision after primary total hip arthroplasty among statin users: a nationwide population-based nested case-control study. J Bone Joint Surg Am. 2010;92:1063–1072.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Vanessa Chiu, MPH, Harry E. Rubash, MD, and Thomas P. Vail, MD, for their assistance.

Financial support

Financial support was received from the Orthopaedic Research and Education Foundation. One or more of the authors (SK, KO, EL) are employees of Exponent, Inc. One or more of the authors (DJB) receives consulting income and royalties from DePuy, Inc.

Author information

Authors and Affiliations

  1. UCSF Department of Orthopaedic Surgery and Philip R. Lee Institute for Health Policy Studies, University of California, 500 Parnassus, MU 320W, San Francisco, CA, 94143-0728, USA

    Kevin J. Bozic MD, MBA

  2. Exponent, Inc, Menlo Park, CA, USA

    Edmund Lau MS

  3. Exponent, Inc, Philadelphia, PA, USA

    Steven Kurtz PhD & Kevin Ong PhD

  4. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA

    Daniel J. Berry MD

Authors
  1. Kevin J. Bozic MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Edmund Lau MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Steven Kurtz PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kevin Ong PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel J. Berry MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kevin J. Bozic MD, MBA.

Additional information

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

This work was performed at the University of California, San Francisco and Exponent, Inc.

About this article

Cite this article

Bozic, K.J., Lau, E., Kurtz, S. et al. Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKA. Clin Orthop Relat Res 470, 130–137 (2012). https://doi.org/10.1007/s11999-011-2043-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-011-2043-3

Keywords

Search

Navigation