Matched Cohort Analysis of Total Hip Arthroplasty in Patients With and Without Parkinson's Disease: Complications, Mortality, Length of Stay, and Hospital Charges

Total knee arthroplasty in schizophrenia patients: early complications and cost in a propensity-matched national database study

INTRODUCTION

Studies investigating the link between mental health disorders and complications following total knee arthroplasty (TKA) have found worse outcomes in individuals with such disorders. Therefore, risk factors and outcomes following TKA in patients with schizophrenia should be better understood. This study aims to investigate cost and duration of hospital stay, inpatient complications, and mortality associated with TKA in patients with schizophrenia.

MATERIALS AND METHODS

Utilizing the NIS database from 2016 to 2019, patients that underwent TKA were selected using ICD-10 codes. The selected patients were classified into a schizophrenia or control group and cost, hospitalization length, complications, and mortality rates were compared between the two groups in an unmatched and matched analysis.

RESULTS

Our study dataset consisted of 558,371 patients that underwent a TKA during 2016 to 2019. 1,015 (0.2%) patients in the sample had a diagnosis of schizophrenia while the remaining 557,357 (99.8%) patients had no record of schizophrenia. An unmatched analysis found that schizophrenia patients had longer duration of hospital stay and greater charges incurred. Acute renal failure, myocardial infarction (MI), blood loss anemia, pneumonia, DVT, periprosthetic fracture, prosthetic dislocation, and periprosthetic infections were post-op complications with higher rates in the schizophrenia group. A matched cohort analysis found that schizophrenia patients still had longer duration of hospital stay and greater charges incurred. However, only acute renal failure, blood loss anemia, and pneumonia were found at higher rates in the schizophrenia group following TKA.

CONCLUSIONS

Schizophrenia patients had a significantly longer hospital stay and increased charges acquired during their stay compared to the control group following TKA. Acute renal failure, blood loss anemia, and pneumonia were medical complications with an increased risk following TKA in patients with schizophrenia in a matched analysis. Increased care during the perioperative period following TKA in individuals with schizophrenia is thus warranted.

Unique characteristics of end-of-life hospitalizations in Parkinson disease

Introduction

Persons with Parkinson disease (PD) are hospitalized at higher rates, have longer lengths of stay, and are more likely to die in the hospital than age-matched peers. Although prior studies have compared inpatient outcomes between persons with and without PD, little is known about inpatient outcomes across the PD trajectory, or whether hospitalizations occurring in the last 6 months of life differ from earlier hospitalizations.

Methods

This cross-sectional study compared Medicare Part A and B beneficiaries aged 65 and older with a qualifying PD diagnosis who were hospitalized in 2017: decedents who died between 7/1/2017 and 12/31/2017 from all causes and were hospitalized at least once in their last 6 months of life, and non-decedents who were hospitalized between 1/1/2017 and 6/30/2017 and lived 6 or more months after discharge. End-of-life (EoL) hospitalizations were defined as those occurring in the last 6 months of life. Descriptive analyses compared patient-level variables (e.g., demographics, comorbidities, treatment intensity) and encounter-level variables (e.g., length of stay, total charges) between groups. Multivariable logistic regression models also compared rates of intensive care unit (ICU) admission and 30-day readmission between hospitalized decedents and hospitalized non-decedents, adjusting for age, sex, race/ethnicity, rural residence, and Charlson Comorbidity Index Score.

Results

Of 26,492 Medicare decedents with PD, 16,187 (61.1%) were hospitalized in their last 6 months of life. Of 347,512 non-decedents with PD, 62,851 (18.1%) were hospitalized in a 6-month period. Hospitalized decedents were slightly older than hospitalized non-decedents (82.3 [SD 7.40] vs. 79.5 [SD 7.54] years) and had significantly more comorbidities. Compared to non-EoL hospitalizations, EoL hospitalizations were slightly longer (5 [IQR 3-9] vs. 4 [IQR 3-7] days) and more expensive based on total charges per admission ($36,323 [IQR 20,091-69,048] vs. $32,309 [IQR 18,789-57,756]). In covariate-adjusted regression models using hospitalized non-decedents as the reference group, hospitalized decedents were more likely to experience an ICU admission (AOR 2.36; CI 2.28-2.45) and 30-day readmission (AOR 2.43; CI 2.34-2.54).

Discussion

Hospitalizations occurring in the last 6 months of life among persons with PD in the United States are longer, more costly, and more resource intensive than earlier hospitalizations and may stem from medical comorbidities. Once hospitalized, ICU admission and 30-day readmission may aid in prognostication and serve as markers of transition to the EoL period.

Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review

Background

As operative techniques and implant design have evolved over time, total hip arthroplasty (THA) is increasingly being carried out for patients with neurological impairment. This patient group places unique surgical challenges to the arthroplasty surgeon, which may include contractures, instability, and altered muscular tone. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival following THA for patients with neurological conditions affecting the hip. Thus, we aim to support orthopaedic surgeon decision-making when considering and planning THA for these patients.

Methods

A systematic review was performed as per Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the PubMed/Medline OVID, Cochrane, and Embase databases. All studies reporting the outcomes of THA in the neurological population which met defined inclusion criteria were included.

Results

From an initial screen of 1820 studies, 45 studies with a total of 36,251 THAs were included in the final selection. All 45 studies reported complication rates, with controls included in 16 for comparison. High complication rates were observed following THA in the neurologically impaired population, most notably dislocation with observed rates up to 10.6%. An improvement was noted in all 36 studies (1811 THAs) which reported upon patient-reported outcomes.

Conclusions

THA may be beneficial in the selected patients with neurological conditions, to reduce pain and improve function. There is an increased risk of complications which require careful consideration when planning the operation and open discussion with prospective patients and caregivers before proceeding with surgery.

Outcomes of hip arthroplasty in Parkinson's disease: a meta-analysis and systematic review

PURPOSE

Hip arthroplasty in Parkinson's disease (PD) is considered to be associated with higher mortality, perioperative complications, and worse clinical outcomes. The purpose of this study was to evaluate the outcomes of hip arthroplasty in PD.

METHODS

The PUBMED, EMBASE, and Cochrane Library databases were searched for all available studies comparing the outcomes of hip arthroplasty in PD and non-PD patients. The quality of the studies was scored using the Newcastle-Ottawa scale (NOS). Meta-analysis was performed using Stata 12.0 software.

RESULTS

Six retrospective cohort studies with a total of 59,878 patients were included. Among them, there were 15,313 patients in the Parkinson's group and 44,565 in the non-Parkinson's group. Results showed that patients in the Parkinson's group were more likely to have periprosthetic fracture (OR = 7.93, 95% CI, 1.96-32.04; P = 0.004), revision surgery (OR = 2.33, 95% CI, 1.37-3.98; P = 0.002), deep vein thrombosis (OR = 2.34, 95% CI, 1.56-3.49; P < 0.01), and urinary tract infection (OR = 1.34, 95% CI, 1.20-1.49; P < 0.01) than those in the non-Parkinson's group. The Parkinson's group had a longer hospital stay (WMD = 0.38, 95% CI, 0.24-0.52; P < 0.01) and higher hospitalization costs (WMD = 2487.08, 95% CI, 225.99-4748.17; P = 0.03), but there was no significant difference in short-term postoperative mortality (OR = 1.07, 95% CI, 0.65-1.73; P = 0.80). Hip arthroplasty can significantly improve the function of patients with PD and reduce pain.

CONCLUSION

Although hip arthroplasty in patients with PD is associated with a higher revision rate and potential risk, it does not increase short-term mortality and can reduce pain, improve function, and improve quality of life. The periprosthetic fracture risk and revision rate are significantly higher and should be accounted for when deciding on operative treatment and communicated to patient with PD.

Musculoskeletal pain in Parkinson's disease: a narrative review

The prevalence of musculoskeletal (MSK) pain in people with Parkinson's disease (PD) is higher than that of age-matched controls. In this review, we outline what is known about MSK pain in PD, focusing on the neck, shoulder, knee, hip and low back. We also compare what is known about MSK pain in PD to what is known in older adults without PD. Finally, we outline areas of for future research related to MSK pain in people with PD.

Total hip arthroplasty in Parkinson's disease - A systematic review of the current evidence

This systematic review assessed the efficacy, survivorship, and complications of Total Hip Replacement (THR) in Parkinson's Disease (PD). Databases were searched according to the Preferred Reporting Items for Systematic Reviews. PD patients had higher wound infections, dislocations, peri-prosthetic fractures, and revision surgery compared to their non-PD counterparts. They also had inferior functional outcomes, and longer and expensive hospital admissions. Dual-mobility (DM) implants had the lowest survival rate. THR in PD patients is associated with significant surgical complications and peri-operative challenges. Despite the use of DM implants to minimize instability, there is insufficient evidence on its effectiveness and long-term survivorship.

Functional outcomes after total joint arthroplasty are related to the severity of Parkinson's disease: a mid-term follow-up

BACKGROUND

Performing total joint arthroplasty (TJA) in Parkinson's disease (PD) patients may encounter a higher complication rate or worse functional outcomes compared with common patients. The relationship between PD and clinical outcomes after TJA is not fully understood.

METHODS

Retrospectively, we used manual charts to investigate the clinical outcomes in 41 patients including 24 total hip arthroplasty (THA) patients (28 hips) and 18 total knee arthroplasty (TKA) patients (22 knees) with a diagnosis of PD from 2009 to 2016. The stage of PD was confirmed by Hoehn and Yahr scale. Prosthesis survivorship was estimated with revision for any reason as the endpoint.

RESULT

All the clinical outcomes improved significantly (p < 0.05). Subgroup analysis revealed worse functional outcomes in mid- or end-stage PD patients. Sixteen short-term mild to moderate complications were noted. Two revisions were conducted for hip periprosthetic osteolysis and postoperative knee pain. The prosthesis survivorship at 60 months for TJA, total hip arthroplasty (THA), or total knee arthroplasty (TKA) was 91.6%, 94.1%, and 87.5%, respectively.

CONCLUSION

Patients with PD who underwent TJA would result in excellent pain relief and gain of function. However, patients at late-stage PD may suffer from functional loss. The effectiveness of TJA in patients with severe PD remains a concern. Physician should help delay the progression of PD which may optimize and stabilize the functional outcomes of TJA.

Effect of Parkinson's disease on primary total joint arthroplasty outcomes: A meta-analysis of matched control studies

BACKGROUND

Currently, no meta-analysis exists elucidate the outcomes of total joint arthroplasty (TJA) in patients with Parkinson's disease (PD). The aim of this study was to investigate the outcomes of TJA in patients with PD with respect to complication and revision in comparison to a TJA cohort without PD.

METHODS

MEDLINE, Scopus, EMBASE, and Cochrane Library databases were searched with English language restrictions. The primary outcome measures were complications and revision, whereas the secondary outcomes included length of stay (LOS) and total charge.

RESULTS

Seven studies with a total of 124163 patients were included. The most important finding from our study was that PD patients had a 42% higher risk for any medical complication (P = 0.004) and a 65% higher risk for any surgical complication (P = 0.01) compared to the matched cohort. Specifically, PD was associated with increased superficial wound infection (P = 0.006), dislocation (P = 0.01), deep vein thrombosis (DVT) (P = 0.02), LOS (P = 0.0005), and total hospital charges (P < 0.00001). However, PD did not increase the risks for periprosthetic infection (P = 0.32) and revision (P = 0.17).

CONCLUSIONS

Patients with PD are at increased risk for medical complication and surgery complications, particularly superficial wound infection, dislocation, and DVT as compared to patients without PD. PD patients also exhibit increased LOS and total hospital charges. However, PD did not increase the risks for periprosthetic infection and revision.