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J Knee Surg 2021; 34(12): 1318-1321
DOI: 10.1055/s-0040-1708850
Original Article

Does Increasing Patient Complexity Have an Effect on Medical Outcomes and Lengths-of-Stay after Total Knee Arthroplasty?

Hiba K. Anis
1   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Nipun Sodhi
2   Department of Orthopaedic Surgery, Long Island Jewish Medical Center, New Hyde Park, New York
,
Alexander J. Acuña
3   School of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
,
Alexander Roth
1   Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Rushabh Vakharia
4   Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, Florida
,
Jared M. Newman
5   Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
,
Syed H. Mufarrih
6   Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
,
Eric Grossman
7   Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, New York, New York
,
Martin W. Roche
4   Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, Florida
,
Michael A. Mont
6   Department of Orthopedic Surgery, Northwell Hospital Lenox Hill, New York, New York
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Abstract

A greater number of medically complex patients with multiple comorbidities are now more readily considered for total knee arthroplasty (TKA). Therefore, the purpose of this study was to determine whether comorbidity burden, measured with the Elixhauser Comorbidity Index (ECI), correlated with 90-day medical complications and longer in-hospital lengths-of-stay (LOS) in TKA patients. The PearlDiver supercomputer was queried for all primary TKA patients in the Medicare Standard Analytic Files from 2005 to 2014 using International Classification of Disease, 9th edition codes. Patients were included based on ECI scores, ranging from 1 to 5. ECI 1 patients served as the control cohort, while ECI 2, 3, 4, and 5 patients were considered study cohorts. Each study cohort was matched based on age and gender to the control cohort, resulting in a total of 715,398 patients included for analysis (ECI 1, n = 144,072; ECI 2, n = 144,072; ECI 3, n = 144,072; ECI 4, n = 144,072; ECI 5, n = 139,110). Logistic regression analyses were performed to compare 90-day medical complications and Welch's t-tests were performed to compare LOS between the cohorts. Patients with higher ECI scores were more likely to develop medical complications and have longer LOS compared with matched patients in the control cohort. Compared with matched ECI 1 patients, patients with ECI scores of 2 (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.14–1.24), 3 (OR: 1.27, 95% CI: 1.21–1.32), 4 (OR: 1.32, 95% CI: 1.27–1.38), and 5 (OR: 1.33, 95% CI: 1.27–1.39) were significantly more likely to develop 90-day medical complications. Additionally, the mean LOS of patients in the ECI 2 (2.59 ± 1.49 vs. 2.73 ± 1.52 days), ECI 3 (2.59 ± 1.49 vs. 2.88 ± 1.51 days; p < 0.001), ECI 4 (2.59 ± 1.49 vs. 3.01 ± 1.56 days; p < 0.001), and ECI 5 (2.61 ± 1.49 vs. 3.14 ± 1.61 days; p < 0.001) groups were significantly longer than the mean LOS in the control ECI 1 group. In an increasingly complex patient population, associations between comorbidities and outcomes after TKA procedures can guide providers on how to modify their pre- and postoperative care. These results demonstrate that higher ECI scores are associated with a greater likelihood of 90-day medical complications and longer in-hospital LOS.

Keywords

knee arthroplasty - complex patients - complications


Publication History

Received: 18 July 2019

Accepted: 07 February 2020

Article published online:
08 April 2020

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