J Knee Surg 2022; 35(12): 1306-1311
DOI: 10.1055/s-0041-1723014
Original Article

Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

Samuel J. Swiggett
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Angelo Mannino
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
,
Joseph O. Ehiorobo
2   Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, New York
,
Martin W. Roche
3   Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, Florida
,
Michael A. Mont
4   Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, Manhattan, New York
,
Orry Erez
1   Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
› Institutsangaben
Funding None.

Abstract

The impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.



Publikationsverlauf

Eingereicht: 14. August 2020

Angenommen: 17. Dezember 2020

Artikel online veröffentlicht:
05. Februar 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Basques BA, Bell JA, Fillingham YA, Khan JM, Della Valle CJ. Gender differences for hip and knee arthroplasty: complications and healthcare utilization. J Arthroplasty 2019; 34 (08) 1593-1597.e1
  • 2 O'Connor MI. Osteoarthritis of the hip and knee: sex and gender differences. Orthop Clin North Am 2006; 37 (04) 559-568
  • 3 Hame SL, Alexander RA. Knee osteoarthritis in women. Curr Rev Musculoskelet Med 2013; 6 (02) 182-187
  • 4 Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum 1987; 30 (08) 914-918
  • 5 Srikanth VK, Fryer JL, Zhai G, Winzenberg TM, Hosmer D, Jones G. A meta-analysis of sex differences prevalence, incidence and severity of osteoarthritis. Osteoarthr Cartil 2005; 13 (09) 769-781
  • 6 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
  • 7 Gen LY, Bin Abd Razak HR, Chi CH, Chye TH. No gender-based differences in outcomes after conventional total knee arthroplasty in Asians. J Arthroplasty 2015; 30 (09) 1548-1550
  • 8 Perruccio AV, Fitzpatrick J, Power JD. et al. Sex-modified effects of depression, low back pain, and comorbidities on pain after total knee arthroplasty for osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72 (08) 1074-1080
  • 9 Hettrich CM, Hammoud S, LaMont LE, Arendt EA, Hannafin JA. Sex-specific analysis of data in high-impact orthopaedic journals: how are we doing?. Clin Orthop Relat Res 2015; 473 (12) 3700-3704
  • 10 Whitlock KG, Piponov HI, Shah SH, Wang OJ, Gonzalez MH. Gender role in total knee arthroplasty: a retrospective analysis of perioperative outcomes in US patients. J Arthroplasty 2016; 31 (12) 2736-2740
  • 11 Vakharia RM, Cohen-Levy WB, Vakharia AM, Donnally III CJ, Law TY, Roche MW. Sleep apnea increases ninety-day complications and cost following primary total joint arthroplasty. J Arthroplasty 2019; 34 (05) 959-964.e1
  • 12 Donnally III CJ, Vakharia RM, Rush III AJ. et al. Fibromyalgia as a predictor of increased postoperative complications, readmission rates, and hospital costs in patients undergoing posterior lumbar spine fusion. Spine 2019; 44 (04) E233-E238
  • 13 Sabeh KG, Rosas S, Buller LT, Freiberg AA, Emory CL, Roche MW. The impact of medical comorbidities on primary total knee arthroplasty reimbursements. J Knee Surg 2019; 32 (06) 475-482
  • 14 Kurowicki J, Rosas S, Khlopas A. et al. Impact of perioperative hba1c on reimbursements in diabetes mellitus patients undergoing total hip arthroplasty: a nationwide analysis. J Arthroplasty 2018; 33 (07) 2038-2042
  • 15 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 (05) 373-383
  • 16 Menendez ME, Neuhaus V, van Dijk CN, Ring D. The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res 2014; 472 (09) 2878-2886
  • 17 Cancienne JM, Diduch DR, Werner BC. High altitude is an independent risk factor for postoperative symptomatic venous thromboembolism after knee arthroscopy: a matched case-control study of Medicare patients. Arthroscopy 2017; 33 (02) 422-427
  • 18 Chen S-Y, Feng Z, Yi X. A general introduction to adjustment for multiple comparisons. J Thorac Dis 2017; 9 (06) 1725-1729
  • 19 Vakharia AM, Cohen-Levy WB, Vakharia RM, Sodhi N, Mont MA, Roche MW. Perioperative complications in patients with rheumatoid arthritis following primary total knee arthroplasty: an analysis of 102,898 patients. J Knee Surg 2019; 32 (11) 1075-1080
  • 20 Cancienne JM, Dempsey IJ, Holzgrefe RE, Brockmeier SF, Werner BC. Is hepatitis c infection associated with a higher risk of complications after total shoulder arthroplasty?. Clin Orthop Relat Res 2016; 474 (12) 2664-2669
  • 21 Anía BJ, Suman VJ, Fairbanks VF, Rademacher DM, Melton III LJ. Incidence of anemia in older people: an epidemiologic study in a well defined population. J Am Geriatr Soc 1997; 45 (07) 825-831
  • 22 Guralnik JM, Eisenstaedt RS, Ferrucci L, Klein HG, Woodman RC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood 2004; 104 (08) 2263-2268
  • 23 Gombotz H, Schreier G, Neubauer S, Kastner P, Hofmann A. Gender disparities in red blood cell transfusion in elective surgery: a post hoc multicentre cohort study. BMJ Open 2016; 6 (12) e012210
  • 24 Mantilla CB, Horlocker TT, Schroeder DR, Berry DJ, Brown DL. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology 2002; 96 (05) 1140-1146
  • 25 Willis-Owen CA, Konyves A, Martin DK. Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 2010; 92 (08) 1128-1133
  • 26 Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am 2009; 91 (01) 38-47
  • 27 Alvarez AP, Demzik AL, Alvi HM, Hardt KD, Manning DW. Risk factors for postoperative urinary tract infections in patients undergoing total joint arthroplasty. Adv Orthop 2016; 2016: 7268985
  • 28 Rasouli MR, Maltenfort MG, Purtill JJ, Hozack WJ, Parvizi J. Has the rate of in-hospital infections after total joint arthroplasty decreased?. Clin Orthop Relat Res 2013; 471 (10) 3102-3111
  • 29 Ko SB. Perioperative stroke: pathophysiology and management. Korean J Anesthesiol 2018; 71 (01) 3-11
  • 30 Turtzo LC, McCullough LD. Sex differences in stroke. Cerebrovasc Dis 2008; 26 (05) 462-474
  • 31 Meek RMD, Norwood T, Smith R, Brenkel IJ, Howie CR. The risk of peri-prosthetic fracture after primary and revision total hip and knee replacement. J Bone Joint Surg Br 2011; 93 (01) 96-101
  • 32 Toogood PA, Vail TP. Periprosthetic fractures: a common problem with a disproportionately high impact on healthcare resources. J Arthroplasty 2015; 30 (10) 1688-1691
  • 33 Friedman R, Homering M, Holberg G, Berkowitz SD. Allogeneic blood transfusions and postoperative infections after total hip or knee arthroplasty. J Bone Joint Surg Am 2014; 96 (04) 272-278
  • 34 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 (07) 1710-1715
  • 35 PearlDiver, No Title. Heal Res Res Capab. 2017 :1. Accessed July 22, 2019 at: http://www.pearldiverinc.com/researchinfo.html