Abstract
Background
Although risk factors for periprosthetic joint infection (PJI) and mortality after total hip arthroplasty (THA) have been identified, interactions between specific patient risk factors are poorly understood. Therefore, it is difficult for surgeons to counsel patients on their individual risk of PJI or mortality after THA.
Questions/purposes
We evaluated the interaction between patient clinical and demographic factors on the risk of PJI and mortality after THA and developed an electronic risk calculator for estimating the patient-specific risk of PJI and mortality in Medicare patients with THA.
Methods
We used the Medicare 5% sample claims database to calculate the risk of PJI within 2 years and mortality within 90 days after THA in 53,252 Medicare patients with primary THAs between 1998 and 2009. Logistic regression using 29 comorbid conditions, age, sex, race, and socioeconomic status were used as inputs to develop an electronic risk calculator to estimate patient-specific risk of PJI and mortality after THA.
Results
The overall 2-year risk of PJI and 90-day risk of mortality after primary THA were 2.07% and 1.30%, respectively. White women aged 70 to 74 years with alcohol abuse, depression, electrolyte disorder, peptic ulcer disease, urinary tract infection, rheumatologic disease, preoperative anemia, cardiopulmonary (cardiac arrhythmia, congestive heart failure, ischemic heart disease, chronic pulmonary disease) comorbidities, and peripheral vascular disease were at highest risk for PJI. White women aged 65 to 69 years with electrolyte disorder, hemiplegia/paraplegia, hypertension, hypothyroidism, metastatic tumor, preoperative anemia, coagulopathy, cardiopulmonary (congestive heart failure, chronic pulmonary disease) and psychiatric (psychoses, depression) comorbidities, malignancies, and peripheral vascular disease were at highest risk for mortality. An electronic risk calculator was developed to estimate the risk of PJI and mortality in Medicare patients with THA.
Conclusions
This electronic risk calculator can be used to counsel Medicare patients regarding their patient-specific risks of PJI and mortality after THA.
Level of Evidence
Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Acknowledgments
We thank Doruk Baykal BS, Drexel University, Philadelphia, PA, USA, for assistance in programming the app and Vanessa Chan MPH, for help in preparing this manuscript.
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The institution of one or more of the authors (KJB) has received, during the study period, funding from the Orthopaedic Research and Education Foundation (Rosemont, IL, USA). One of the authors (SMK) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $100,000, from Exponent, Inc (Philadelphia, PA, USA). One of the authors (KO) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $100,000, from Exponent, Inc. One of the authors (EL) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $100,000, from Exponent, Inc. One of the authors (DJB) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $100,000, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TPV) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $10,000, from DePuy Orthopaedics, Inc. One of the authors (HER) certifies that he has received or may receive payments or benefits, during the study period, an amount in excess of $100,000, from Zimmer, Inc (Warsaw, IN, USA).
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.
Each author certifies that the institutions where the work was performed approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
This work was performed at University of California, San Francisco (San Francisco, CA, USA) and Exponent, Inc (Philadelphia, PA, USA; Menlo Park, CA, USA).
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Bozic, K.J., Ong, K., Lau, E. et al. Estimating Risk in Medicare Patients With THA: An Electronic Risk Calculator for Periprosthetic Joint Infection and Mortality. Clin Orthop Relat Res 471, 574–583 (2013). https://doi.org/10.1007/s11999-012-2605-z
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DOI: https://doi.org/10.1007/s11999-012-2605-z