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Sleiman AG, Vallette N, Milto AJ, Revelt N, Scaife SL, Thuppal SV. The effect of autoimmune skin disorders on post-operative outcomes following arthroplasty. Surgeon 2023; 21:e292-e300. [PMID: 37028955 DOI: 10.1016/j.surge.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/17/2023] [Accepted: 03/20/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION The impact of autoimmune skin disorders on post-operative outcomes after TJA is conflicting and studies are limited by small sample sizes. The purpose of this study is to analyze a range of common autoimmune skin disorders and identify whether an increased risk of post-operative complication exists after total joint arthroplasty. METHODS Data was collected from NIS database for patients diagnosed with autoimmune skin disorder (psoriasis, lupus, scleroderma, atopic dermatitis) and who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA), or other TJA (shoulder elbow, wrist, ankle) between 2016 and 2019. Demographic, social, and comorbidity data was collected. Multivariate regression analyses were performed to assess the independent influence of autoimmune skin disorder on each post-operative outcome including implant infection, transfusion, revision, length of stay, cost, and mortality. RESULTS Among 55,755 patients with autoimmune skin disease who underwent TJA, psoriasis was associated with increased risk of periprosthetic joint infection following THA (odds ratio 2.44 [1.89-3.15]) and increased risk of transfusion following TKA (odds ratio 1.33 [1.076-1.64]). Similar analyses were performed for systemic lupus erythematosus, atopic dermatitis, and scleroderma, however no statistically significant associations were observed in any of the six collected post-operative outcomes. CONCLUSION This study suggests psoriasis is an independent risk factor for poorer post-operative outcomes following total joint arthroplasty, however similar risk was not observed for other autoimmune skin disorders such as lupus, atopic dermatitis, or scleroderma.
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Affiliation(s)
- Anthony G Sleiman
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA; Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62702, USA
| | - Noah Vallette
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA
| | - Anthony J Milto
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA
| | - Nicolas Revelt
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA
| | - Steven L Scaife
- Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62702, USA
| | - Sowmyanarayanan V Thuppal
- Division of Orthopedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL P.O. Box 19679, Springfield, IL, 62794, USA; Center for Clinical Research, Southern Illinois University School of Medicine, 201 E. Madison St., Springfield, IL, 62702, USA.
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Driskill E, Zhang Z, Chi J, Cui Q. Increased rate of complications following total knee arthroplasty in patients with systemic sclerosis. INTERNATIONAL ORTHOPAEDICS 2023; 47:2563-2569. [PMID: 37354225 DOI: 10.1007/s00264-023-05873-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Outcomes after total knee arthroplasty (TKA) for patients with systemic sclerosis (SSc) are poorly documented in the literature. The purpose of this study was to evaluate SSc as a potential risk factor for increased rate of complications after TKA. METHODS Using the PearlDiver Mariner database, 2,002 patients with SSc undergoing primary TKA were identified and compared to matched controls of 19,892 patients without SSc. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to two years. 90-day ED-visit and inpatient readmission were also documented. RESULTS Compared to the matched controls, patients with SSc demonstrated higher rates of medical complications such as cerebrovascular accident (1.5% vs 0.6%, p < 0.001), myocardial infarction (1.3% vs 0.3%, p < 0.001), and sepsis (1.1% vs 0.4%, p < 0.001). Additionally, patients with SSc displayed elevated rates of surgical complications, including wound complications (3.9% vs 2.2%, p < 0.001) and aseptic loosening at 90 days (0.2% vs 0.1%; OR 3.53 [1.13-9.28]), one year (0.7% vs 0.4%; OR 1.78 [0.96-3.05]), and two years (1.4% vs 0.9%; OR 1.68 [1.10-2.45]). Patients with SSc also had higher rates of emergency department visits (21.2% vs 11.4%, p < 0.001). CONCLUSIONS Patients with SSc are at higher risks of postoperative complications, encompassing both medical and surgical complications. Specifically, patients with SSc have a significantly higher likelihood of experiencing wound complications, cerebrovascular accident, and myocardial infarction. It is crucial for orthopaedic surgeons and patients alike to consider the elevated risks when determining a course of TKA for patients with SSc.
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Affiliation(s)
- Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
- , Charlottesville, USA.
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Martin Calderon L, Chaudhury M, Pope JE. Healthcare utilization and economic burden in systemic sclerosis: a systematic review. Rheumatology (Oxford) 2021; 61:3123-3131. [PMID: 34849627 DOI: 10.1093/rheumatology/keab847] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Systemic Sclerosis (SSc) is characterized by vasculopathy, fibrosis of skin and internal organs, and autoimmunity with complications including interstitial lung disease, pulmonary hypertension, and digital ulcers with substantial morbidity and disability. Patients with SSc may require considerable healthcare resources with economic impact. The purpose of this systematic review was to provide a narrative synthesis of the economic impact and healthcare resource utilization associated with SSc. METHODS MEDLINE and EMBASE were searched from inception to January 20th, 2021. Studies were included if they provided information regarding the total, direct and indirect cost of SSc. The cost of SSc subtypes and associated complications was determined. Risk of bias assessments through the Joanna Briggs Institute cross-sectional and case series checklists, and the Newcastle-Ottawa Cohort and Case-Control study scales were performed. A narrative synthesis of included studies was planned. RESULTS 1777 publications were retrieved, of which 33 were included representing 20 cross-sectional, 10 cohort, and 3 case-control studies. Studies used various methods of calculating cost including prevalence-based cost-of-illness approach and health resource units cost analysis. Overall SSc total annual cost ranged from USD$14 959-$23 268 in USA, CAD$10 673-$18 453 in Canada, €4,607-€30 797 in Europe, and AUD$7,060-$11 607 in Oceania. Annual cost for SSc-associated interstitial lung disease and pulmonary hypertension was USD$31 285-$55 446 and $44 454-$63 320, respectively. CONCLUSION Cost-calculation methodology varied greatly between included studies. SSc represents significant patient and health resource economic burden. SSc-associated complications increase economic burden and are variable depending on geographical location, and access.
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Affiliation(s)
- Leonardo Martin Calderon
- Schulich School of Medicine and Dentistry, University of Western Ontario, Department of Medicine, London, Ontario, Canada
| | - Mitali Chaudhury
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Janet E Pope
- Schulich School of Medicine and Dentistry, University of Western Ontario, Division of Rheumatology, St. Joseph's Health Care, London, Ontario, Canada
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