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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
,
Rushabh M. Vakharia 
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
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Funding None.
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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.

Keywords

total knee arthroplasty - gender - complications - readmission - Medicare


Publication History

Received: 14 August 2020

Accepted: 17 December 2020

Article published online:
05 February 2021

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