Download PDF
J Knee Surg 2019; 32(04): 337-343
DOI: 10.1055/s-0038-1641155
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Previous History of Breast Cancer Increases Rates of Pulmonary Embolism and Costs after Total Knee Arthroplasty: An Evaluation of 185,114 Matched Patients

Samuel Rosas
1   Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
,
T. David Luo
1   Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
,
Alexander H. Jinnah
1   Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
,
Alejandro Marquez-Lara
1   Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
,
Martin W. Roche
2   Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida
,
Cynthia L. Emory
1   Department of Orthopedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
› Author Affiliations
Further Information

Publication History

01 December 2017

25 February 2018

Publication Date:
04 April 2018 (online)

    Permissions and Reprints

Abstract

Risk factors for adverse events after total knee arthroplasty (TKA) relating to malignancy have not been well studied. Thus, the purpose of this study was to conduct a retrospective case–control outcome and cost analysis after TKA in this population. Patients with a history of breast cancer (BrCa) were identified based on the International Classification of Disease 9th revision codes. An age- and sex-matched cohort was also identified of patients without a history of BrCa. Complications, length of stay, comorbidity burden, and reimbursements were tracked at 90 days. Each cohort comprised 92,557 patients. Length of stay was similar between cohorts (p = 0.627). Comorbidity status and incidence of pulmonary embolism (PE), lower extremity ultrasound, and chest computed tomography (CT) use were higher in patients with a history of BrCa (p < 0.05 for all). Control patients had a lower incidence of acute myocardial infarction (0.14 vs. 0.21%; p < 0.001). Surgical complications were similar. The 90-day reimbursements were greater in patients with a history of BrCa (US$13,990 vs. US$13,033 for controls; p = 0.021). Surgeons should be aware of the increased risk of PE after TKA in patients with a history of BrCa as well as increased 90-day costs, which warrant great attention.

Keywords

total knee arthroplasty - cancer - breast - outcomes - cost
 

  • References

  • 1 Jain NB, Higgins LD, Ozumba D. , et al. Trends in epidemiology of knee arthroplasty in the United States, 1990-2000. Arthritis Rheum 2005; 52 (12) 3928-3933
    CrossrefPubMedGoogle Scholar
  • 2 Laucis NC, Chowdhury M, Dasgupta A, Bhattacharyya T. Trend toward high-volume hospitals and the influence on complications in knee and hip arthroplasty. J Bone Joint Surg Am 2016; 98 (09) 707-712
    CrossrefPubMedGoogle Scholar
  • 3 Mehrotra C, Remington PL, Naimi TS, Washington W, Miller R. Trends in total knee replacement surgeries and implications for public health, 1990-2000. Public Health Rep 2005; 120 (03) 278-282
    CrossrefPubMedGoogle Scholar
  • 4 Choi YJ, Ra HJ. Patient satisfaction after total knee arthroplasty. Knee Surg Relat Res 2016; 28 (01) 1-15
    CrossrefPubMedGoogle Scholar
  • 5 Skou ST, Roos EM, Laursen MB. , et al. A randomized, controlled trial of total knee replacement. N Engl J Med 2015; 373 (17) 1597-1606
    CrossrefPubMedGoogle Scholar
  • 6 Karam JA, Huang RC, Abraham JA, Parvizi J. Total joint arthroplasty in cancer patients. J Arthroplasty 2015; 30 (05) 758-761
    CrossrefPubMedGoogle Scholar
  • 7 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin 2016; 66 (01) 7-30
    CrossrefPubMedGoogle Scholar
  • 8 Millstone DB, Perruccio AV, Badley EM, Rampersaud YR. Factors associated with adverse events in inpatient elective spine, knee, and hip orthopaedic surgery. J Bone Joint Surg Am 2017; 99 (16) 1365-1372
    CrossrefPubMedGoogle Scholar
  • 9 Blann AD, Dunmore S. Arterial and venous thrombosis in cancer patients. Cardiol Res Pract 2011; 2011: 394740
    PubMedGoogle Scholar
  • 10 Caine GJ, Stonelake PS, Lip GYH, Kehoe ST. The hypercoagulable state of malignancy: pathogenesis and current debate. Neoplasia 2002; 4 (06) 465-473
    CrossrefPubMedGoogle Scholar
  • 11 Connolly GC, Khorana AA, Kuderer NM, Culakova E, Francis CW, Lyman GH. Leukocytosis, thrombosis and early mortality in cancer patients initiating chemotherapy. Thromb Res 2010; 126 (02) 113-118
    CrossrefPubMedGoogle Scholar
  • 12 Cameron AC, Touyz RM, Lang NN. Vascular complications of cancer chemotherapy. Can J Cardiol 2016; 32 (07) 852-862
    CrossrefPubMedGoogle Scholar
  • 13 Hopewell JW. Radiation-therapy effects on bone density. Med Pediatr Oncol 2003; 41 (03) 208-211
    CrossrefPubMedGoogle Scholar
  • 14 Groenen KH, Pouw MH, Hannink G. , et al. The effect of radiotherapy, and radiotherapy combined with bisphosphonates or RANK ligand inhibitors on bone quality in bone metastases. A systematic review. Radiother Oncol 2016; 119 (02) 194-201
    CrossrefPubMedGoogle Scholar
  • 15 Howlader NNA, Krapcho M, Miller D. , et al , eds. SEER Cancer Statistics Review, 1975–2014. Bethesda, MD: National Cancer Institute. Available at: https://seer.cancer.gov/csr/1975_2014/
    PubMedGoogle Scholar
  • 16 Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67 (01) 7-30
    CrossrefPubMedGoogle Scholar
  • 17 Heindel P, Tuchman A, Hsieh PC. , et al. Reoperation rates after single-level lumbar discectomy. Spine 2017; 42 (08) E496-E501
    CrossrefPubMedGoogle Scholar
  • 18 Roche MW, Law TY, Triplet JJ, Hubbard ZS, Kurowicki J, Rosas S. Effect of hypoglycemia on the incidence of revision in total knee arthroplasty. J Arthroplasty 2017; 32 (02) 499-502
    CrossrefPubMedGoogle Scholar
  • 19 Rosas S, Sabeh KG, Buller LT, Law TY, Roche MW, Hernandez VH. Medical comorbidities impact the episode-of-care reimbursements of total hip arthroplasty. J Arthroplasty 2017; 32 (07) 2082-2087
    CrossrefPubMedGoogle Scholar
  • 20 Sabeh KG, Rosas S, Buller LT, Roche MW, Hernandez VH. The impact of discharge disposition on episode-of-care reimbursement after primary total hip arthroplasty. J Arthroplasty 2017; 32 (10) 2969-2973
    CrossrefPubMedGoogle Scholar
  • 21 Cardoso F, Costa A, Senkus E. , et al. 3rd ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 3). Ann Oncol 2017; 28 (01) 16-33
    CrossrefPubMedGoogle Scholar
  • 22 Shahi A, Chen AF, Tan TL, Maltenfort MG, Kucukdurmaz F, Parvizi J. The incidence and economic burden of in-hospital venous thromboembolism in the United States. J Arthroplasty 2017; 32 (04) 1063-1066
    CrossrefPubMedGoogle Scholar
  • 23 Dasta JF, Pilon D, Mody SH. , et al. Daily hospitalization costs in patients with deep vein thrombosis or pulmonary embolism treated with anticoagulant therapy. Thromb Res 2015; 135 (02) 303-310
    CrossrefPubMedGoogle Scholar
  • 24 van Erkel AR, van den Hout WB, Pattynama PM. International differences in health care costs in Europe and the United States: do these affect the cost-effectiveness of diagnostic strategies for pulmonary embolism?. Eur Radiol 1999; 9 (09) 1926-1931
    CrossrefPubMedGoogle Scholar
  • 25 Lebel B, Lewallen D. Total knee arthroplasty dislocation: incidence, etiology, and management. J Bone Joint Sur Br 2010; 92-B (Supp_II): 323
    PubMedGoogle Scholar
  • 26 Jethanandani RG, Maloney WJ, Huddleston III JI, Goodman SB, Amanatullah DF. Tibiofemoral dislocation after total knee arthroplasty. J Arthroplasty 2016; 31 (10) 2282-2285
    CrossrefPubMedGoogle Scholar
  • 27 Choksi P, Williams M, Clark PM, Van Poznak C. Skeletal manifestations of treatment of breast cancer. Curr Osteoporos Rep 2013; 11 (04) 319-328
    CrossrefPubMedGoogle Scholar
  • 28 Hansen M, Kjaer M. Sex hormones and tendon. Adv Exp Med Biol 2016; 920: 139-149
    CrossrefPubMedGoogle Scholar
  • 29 Flink BJ, Rivelli SK, Cox EA. , et al. Obstructive sleep apnea and incidence of postoperative delirium after elective knee replacement in the nondemented elderly. Anesthesiology 2012; 116 (04) 788-796
    CrossrefPubMedGoogle Scholar
  • 30 Senkus E, Kyriakides S, Ohno S. , et al; ESMO Guidelines Committee. Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 (Suppl. 05) v8-v30
    CrossrefPubMedGoogle Scholar
  • 31 Chatterjee K, Zhang J, Honbo N, Karliner JS. Doxorubicin cardiomyopathy. Cardiology 2010; 115 (02) 155-162
    CrossrefPubMedGoogle Scholar
  • 32 Lalmohamed A, Vestergaard P, Klop C. , et al. Timing of acute myocardial infarction in patients undergoing total hip or knee replacement: a nationwide cohort study. Arch Intern Med 2012; 172 (16) 1229-1235
    CrossrefPubMedGoogle Scholar
  • 33 Molloy IB, Martin BI, Moschetti WE, Jevsevar DS. Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013. J Bone Joint Surg Am 2017; 99 (05) 402-407
    CrossrefPubMedGoogle Scholar