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Kim NS, Lam AW, Golub IJ, Sheth BK, Vakharia RM, Saleh A, Razi AE. Opioid Use Disorder in Patients Undergoing Primary 1- to 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Readmissions, Complications, and Costs of Care. Global Spine J 2023; 13:1467-1473. [PMID: 34409880 PMCID: PMC10448104 DOI: 10.1177/21925682211037265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. METHODS OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch's t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. RESULTS OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). CONCLUSION The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.
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Affiliation(s)
- Nathan S. Kim
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
- State University of New York (SUNY) Downstate, School of Medicine, Brooklyn, New York, NY, USA
| | - Aaron W. Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Ivan J. Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Bhavya K. Sheth
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Rushabh M. Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
| | - Afshin E. Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, NY, USA
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How to Create an Orthopaedic Arthroplasty Administrative Database Project: A Step-by-Step Guide Part I: Study Design. J Arthroplasty 2023; 38:407-413. [PMID: 36241012 DOI: 10.1016/j.arth.2022.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Use of clinical and administrative databases in orthopaedic surgery research has grown substantially in recent years. It is estimated that approximately 10% of all published lower extremity arthroplasty research have been database studies. The aim of this review is to serve as a guide on how to (1) design, (2) execute, and (3) publish an orthopaedic administrative database arthroplasty project. METHODS In part I, we discuss how to develop a research question and choose a database (when databases should/should not be used), detailing advantages/disadvantages of those most commonly used. To date, the most commonly published databases in orthopaedic research have been the National Inpatient Sample, Medicare, National Surgical Quality Improvement Program, and those provided by PearlDiver. General advantages of most database studies include accessibility, affordability compared to prospective research studies, ease of use, large sample sizes, and the ability to identify trends and aggregate outcomes of multiple health care systems/providers. RESULTS Disadvantages of most databases include their retrospective observational nature, limitations of procedural/billing coding, relatively short follow-up, limited ability to control for confounding variables, and lack of functional/patient-reported outcomes. CONCLUSION Although this study is not all-encompassing, we hope it will serve as a starting point for those interested in conducting and critically reviewing lower extremity arthroplasty database studies.
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Swiggett SJ, Ciminero ML, Weisberg MD, Vakharia RM, Sadeghpour R, Choueka J. Implant-related complications in patients with opioid use disorder undergoing primary shoulder arthroplasties: a matched-controlled analysis. Shoulder Elbow 2022; 14:395-401. [PMID: 35846397 PMCID: PMC9284306 DOI: 10.1177/1758573221994790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this study was to investigate whether patients undergoing primary shoulder arthroplasty with opioid use disorder have higher rates of (1) implant-related complications; (2) in-hospital lengths of stay; (3) readmission rates; and (4) costs of care. METHODS Opioid use disorder patients undergoing primary shoulder arthroplasty were queried and matched in a 1:5 ratio to controls by age, sex, and medical comorbidities within the Medicare database. The query yielded 25,489 patients with (n = 4253) and without (n = 21,236) opioid use disorder. Primary outcomes analyzed included: 2-year implant related complications, in-hospital lengths of stay, 90-day readmission rates, and 90-day costs of care. A p value less than 0.01 was considered statistically significant. RESULTS Opioid use disorder patients had significantly longer in-hospital lengths of stay (3 days vs. 2 days; p < 0.0001) compared to matched controls. Opioid use disorder patients were also found to have higher incidence and odds (OR) of readmission rates (12.84 vs. 7.45%; OR: 1.16, p < 0.0001) and implant-related complications (20.03 vs. 7.95%; OR: 1.82, p < 0.0001). Study group patients also incurred significantly higher 90-day costs of care ($16,918.85 vs. $15,195.37, p < 0.0001). DISCUSSION This study can be used to help further augment efforts to reduce opioid prescriptions from healthcare providers in shoulder arthroplasty settings.
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Affiliation(s)
| | | | | | - Rushabh M Vakharia
- Rushabh M Vakharia, Maimonides Medical Center, 4802
10th Avenue, Brooklyn, NY 11219, USA.
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Terhune EB, Hannon CP, Burnett RA, Della Valle CJ. Preoperative Opioids and the Dose-Dependent Effect on Outcomes After Total Hip Arthroplasty. J Arthroplasty 2022; 37:S864-S870. [PMID: 34942347 DOI: 10.1016/j.arth.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/18/2021] [Accepted: 12/15/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to identify the preoperative daily opioid dose associated with increased complications after primary total hip arthroplasty (THA). METHODS Primary THA patients in the Humana claims database (2007-2020) with an opioid prescription within 3 months prior to surgery were identified. Patients were stratified based on daily opioid dose: Tier 1, <5 milligram morphine equivalents (MME); Tier 2, 5-10 MME; Tier 3, 11-25 MME; Tier 4, 26-50 MME; Tier 5, >50 MME. Each tier was matched 1:1 to opioid-naïve patients. Emergency department (ED) visits, readmissions, and postoperative complications were compared. RESULTS In total, 67,719 patients using preoperative opioids were identified and matched. 17.0% of patients using preoperative opioids visited the ED within 90 days, compared to 13.3% of opioid-naïve patients (P < .001). About 9.5% of patients using preoperative opioids were readmitted within 90 days, compared to 7.4% of opioid-naïve patients (P < .001). When stratified by tier, opioid users in all tiers had higher risk of ED visits and readmission. Rates of superficial infection, periprosthetic joint infection, and dislocation were increased in patients taking preoperative opioids in Tiers 2 through 5. Patients in Tiers 3 through 5 had an increased risk of revision surgery. CONCLUSION Preoperative opioid use is associated with a dose-dependent increase in complications after THA. Just one 5 mg hydrocodone tablet daily leads to a significant increase in ED visits and readmission, while higher doses are associated with dislocation, superficial infection, periprosthetic joint infection, and revision surgery. Continued education regarding the harmful effects of opioids prescribed for the nonoperative treatment of osteoarthritis is still needed. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- E Bailey Terhune
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Charles P Hannon
- Department of Orthopaedic Surgery, Washington University in St Louis, St Louis, MO
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL
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Thamer SB, Lam AW, Golub IJ, Magruder ML, Vakharia RM, Aiyer AA, Abdelgawad AA. Sleep Apnea and Postoperative Medical Complications and Health Care Expenditures Following Open Reduction and Internal Fixation of Bimalleolar Ankle Fractures. Foot Ankle Spec 2022:19386400221098629. [PMID: 35695495 DOI: 10.1177/19386400221098629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Sleep Apnea (SA) is a common sleep disorder that increases postoperative morbidity. There is limited research on how SA influences outcomes following operative fixation of ankle fractures. Therefore, the aim of this study was to determine whether patients who undergo surgical fixation for bimalleolar ankle fractures have higher rates of medical complications and health care expenditures. METHODS A retrospective review from January 1, 2005 to March 31, 2014 was conducted using the parts A and B Medicare Data from PearlDiver database. Patients with and without SA on the day of the primary open reduction and internal fixation (ORIF) of their bimalleolar ankle fractures were queried using the International Classification of Diseases, Ninth Revision codes. Welch'st-tests were used to compare costs of care. A multivariate binomial logistic regression model was used to calculate the odds ratio (OR) of adverse events. A P-value <.001 was considered statistically significant. RESULTS There were 20 560 patients (SA = 3150; comparison cohort = 17 410) who underwent ORIF for bimalleolar ankle fractures during the study period. Sleep apnea patients were found to have significantly higher rates and odds of 90-day medical complications (21.42% vs 7.47%, OR: 3.11, P < .0001) and 90-day costs of care ($7213.12 vs $5415.79, P < .0001). CONCLUSION This research demonstrates an increased risk of postoperative medical complications and health care costs among patients with SA undergoing ORIF for bimalleolar ankle fractures. LEVEL OF EVIDENCE Therapeutic, Level IV: Retrospective.
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Affiliation(s)
- Semran B Thamer
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Aaron W Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Ivan J Golub
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Amr A Abdelgawad
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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Featherall J, Anderson JT, Anderson LA, Bayless K, Anderson Z, Brooke BS, Gililland JM, Buys MJ. A Multidisciplinary Transitional Pain Management Program Is Associated With Reduced Opioid Dependence After Primary Total Joint Arthroplasty. J Arthroplasty 2022; 37:1048-1053. [PMID: 35181448 DOI: 10.1016/j.arth.2022.02.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/30/2021] [Accepted: 02/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Overprescription of opioids after total joint arthroplasty (TJA) increases risks of opioid dependence, overdose, and death. The authors hypothesized that a multidisciplinary, perioperative pain management program (the Transitional Pain Service or TPS) for TJA would lead to fewer patients becoming opioid dependent. METHODS A TPS was implemented at a Veterans Affairs Medical Center focused on nonopioid pain management, cessation support, and prospective data tracking. A historical control, interventional study design was used to assess opioid use at 90 days post-discharge. Secondary analysis of the implementation group included post-operative outcome scores, time to opioid cessation, and median opioid tablets consumed at 90 days. RESULTS Fewer patients in the TPS group demonstrated persistent opioid use at 90 days post-discharge (0.7% vs 9.9%; P = .004). Independent predictors of total opioid tablet prescriptions included TPS (β = -19.41; 95% confidence interval [CI] -35.37 to -3.47), number of tablets prescribed at discharge (β = 1.08; 95% CI 0.86-1.31), and TKA surgery (β = 16.84; 95% CI 4.58-29.10). Under the TPS, median tablets consumed was 20.5 for THA and 36.5 for TKA; median time to cessation was shorter in THA (7 days; 95% CI 2-10) when compared to TKA (13 days; 95% CI 11-16). CONCLUSION In opioid-naïve veterans undergoing TJA, the TPS was associated with a 93% reduction in opioid dependence and a 60% reduction in opioid tablet prescriptions at 90 days post-discharge. Under the TPS, median 90-day opioid consumption was 20.5 and 36.5 tablets for THA and TKA, respectively. Widespread adoption of similar programs may greatly reduce opioid use and dependence in orthopedic patients nationally. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | | | - Lucas A Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT; Department of Orthopaedic Surgery, Veterans Affairs Medical Center, Salt Lake City, UT
| | - Kimberlee Bayless
- Department of Anesthesiology, Veterans Affairs Medical Center, Salt Lake City, UT
| | - Zachary Anderson
- Department of Anesthesiology, Veterans Affairs Medical Center, Salt Lake City, UT
| | | | - Jeremy M Gililland
- Department of Orthopaedics, University of Utah, Salt Lake City, UT; Department of Orthopaedic Surgery, Veterans Affairs Medical Center, Salt Lake City, UT
| | - Michael J Buys
- Department of Anesthesiology, Veterans Affairs Medical Center, Salt Lake City, UT; Department of Anesthesiology, University of Utah, Salt Lake City, UT
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Marchand KB, Vakharia R, Sodhi N, Anis H, Salem HS, Scuderi GR, Mont MA, Roche MW. Impact of Parkinson's Disease on Complications, Readmission Rates, and Costs of Care following Primary Total Knee Arthroplasty. J Knee Surg 2022; 35:21-25. [PMID: 32462645 DOI: 10.1055/s-0040-1710546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Large-scale studies evaluating the effects of Parkinson's disease (PD) on primary total knee arthroplasty (TKA) are limited. The purpose of this study was to determine if PD patients undergoing primary TKA have increased: (1) medical complications; (2) implant-related complications; (3) readmission rates; and (4) costs. A query was performed using an administrative claims database. The study group consisted of all patients undergoing primary TKA who had a history of PD. Matched non-PD patients undergoing primary TKA served as a control group. The query yielded 72,326 patients (PD = 18,082; matching cohort = 54,244). Pearson's chi-square tests, logistic regression analyses, and Welch's t-tests were used to test for significance between the cohorts. Primary TKA patients who had PD were found to have greater incidences and odds of medical complications (4.21 vs. 1.24%; odds ratio [OR]: 3.50, 95% confidence interval [CI]: 3.15-3.89, p < 0.0001) and implant-related complications (5.09 vs. 3.15%; OR: 1.64, 95% CI: 1.51-1.79, p < 0.0001) compared with the matching cohort. Additionally, the rates and odds of 90-day readmission were higher (16.29 vs. 12.66%; OR:1.34, p < 0.0001) and episodes of care costs were significantly greater ($17,105.43 vs. $15,252.34, p < 0.0001) in patients who had PD. Results demonstrate that PD patients undergoing primary TKA had higher incidences of medical and implant-related complications. They also had increased 90-day readmission rates and costs compared with controls. The findings of this study should be used in risk stratification and should inform physician-patient discussion but should not be arbitrarily used to deny access to care.
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Affiliation(s)
- Kevin B Marchand
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Rushabh Vakharia
- Department of Orthopedic Surgery, Holy Cross Hospital, Trinity Health, Fort Lauderdale, Florida
| | - Nipun Sodhi
- Northwell Health Orthopedics, Long Island Jewish Medical Center, New York, New York
| | - Hiba Anis
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Hytham S Salem
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Giles R Scuderi
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Michael A Mont
- Northwell Health Orthopedics, Lenox Hill Hospital, New York, New York
| | - Martin William Roche
- Department of Orthopedic Surgery, Holy Cross Hospital, Trinity Health, Fort Lauderdale, Florida
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Malahias MA, Loucas R, Loucas M, Denti M, Sculco PK, Greenberg A. Preoperative Opioid Use Is Associated With Higher Revision Rates in Total Joint Arthroplasty: A Systematic Review. J Arthroplasty 2021; 36:3814-3821. [PMID: 34247870 DOI: 10.1016/j.arth.2021.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/06/2021] [Accepted: 06/17/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Although preoperative opioid use has been associated with poor postoperative patient-reported outcome measures and delayed return to work in patients undergoing total joint arthroplasty, direct surgery-related complications in patients on chronic opioids are still not clear. Thus, we sought to perform a systematic review of the literature to evaluate the influence of preoperative opioid use on postoperative complications and revision following primary total joint arthroplasty. METHODS Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we queried PubMed, EMBASE, the Cochrane Library, and the ISI Web of Science for studies investigating the influence of preoperative opioid use on postoperative complications following total hip arthroplasty and total knee arthroplasty up to May 2020. RESULTS After applying exclusion criteria, 10 studies were included in the analysis which represented 87,165 opioid users (OU) and 5,214,010 nonopioid users (NOU). The overall revision rate in the OU group was 4.79% (3846 of 80,303 patients) compared to 1.21% in the NOU group (43,719 of 3,613,211 patients). There was a higher risk of aseptic loosening (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.11-1.53, P = .002), periprosthetic fractures (OR 1.89, 95% CI 1.53-2.34, P < .00001), and dislocations (OR 1.26, 95% CI 1.14-1.39, P < .00001) in the OU group compared to the NOU group. Overall, 5 of 6 studies reporting on periprosthetic joint infection (PJI) rates showed statistically significant correlation between preoperative opioid use and higher PJI rates. CONCLUSION There is strong evidence that preoperative opioid use is associated with a higher overall revision rate for aseptic loosening, periprosthetic fractures, and dislocation, and an increased risk for PJI. LEVEL OF EVIDENCE Level III, systematic review.
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Affiliation(s)
- Michael-Alexander Malahias
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY; Department of Orthopedics and Traumatology, Clinica Ars Medica, Gravesano, Ticino, Switzerland
| | - Rafael Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marios Loucas
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Matteo Denti
- Department of Orthopedics and Traumatology, Clinica Ars Medica, Gravesano, Ticino, Switzerland; Department of Orthopaedics, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Peter K Sculco
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY
| | - Alexander Greenberg
- The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY; Hadassah Medical Center, Jerusalem, Israel
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Clinical and Administrative Databases Used in Lower Extremity Arthroplasty Research. J Arthroplasty 2021; 36:3608-3615. [PMID: 34130871 DOI: 10.1016/j.arth.2021.05.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of national databases in lower extremity arthroplasty research has grown rapidly in recent years. We aimed to better characterize available databases by: (1) quantifying the number of these studies in the highest impact arthroplasty journals; (2) comparing respective sample sizes; and (3) contrasting their measured variables/outcomes. METHODS An extensive literature search was conducted to identify all database studies in the top 12 highest impact factor journals that published arthroplasty research between January 1, 2018 and December 31, 2019. A total of 5070 publications were identified. These studies were sorted by both database utilized and journal published. Tables were constructed to compare/contrast databases by metrics and measured outcome parameters including coding, patient sample size, preoperative comorbidities, postoperative complications, and limitations/barriers to their use. RESULTS Four hundred twenty-six database studies (8.4%, range 0.4%-29.7% per journal) were identified, of which 139 were from non-English-speaking arthroplasty databases. Among English-speaking arthroplasty databases, the 5 most common sources were National Surgical Quality Improvement Project (n = 72), Medicare (n = 62, 39 from Medicare Claims and 23 from PearlDiver), Nationwide Inpatient Sample (n = 35), PearlDiver non-Medicare private insurance (n = 18), and Statewide Planning and Research Cooperative System (n = 18). Metrics, outcome parameters, and features of commonly used registries were reviewed. CONCLUSION Database studies constitute an important part of arthroplasty-specific orthopedic research. Their use will continue to grow in the future, and it would be beneficial for clinicians/researchers to be aware of and familiarize themselves with their features to understand which are most appropriate for their work.
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Sylla MM, Gruffi L, Roth ES, Rosato FE, Wong CHJ, Razi AE. How Does Iron Deficiency Anemia Impact Outcomes following Revision Total Hip Arthroplasty? Hip Pelvis 2021; 33:140-146. [PMID: 34552891 PMCID: PMC8440132 DOI: 10.5371/hp.2021.33.3.140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
Purpose Studies have shown the prevalence of iron deficiency anemia (IDA) increasing worldwide, and currently the literature is limited on the impact of IDA on outcomes following revision total hip arthroplasty (RTHA). Therefore, the purpose of this study was to determine whether IDA patients undergoing RTHA have longer: 1) in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care. Materials and Methods A retrospective query of a nationwide administrative claims database was performed. Using Boolean command operations, the study group consisted of all patients in the database undergoing RTHA with IDA; whereas, patients without IDA served as controls. To reduce the effects of confounding, study group patients were matched to controls in a 1:5 ratio by age, sex, and medical comorbidities yielding 92,948 patients with (n=15,508) and without (n=77,440) IDA undergoing revision THA. A P-value less than 0.001 was considered statistically significant. Results IDA patients were found to have significantly longer in-hospital LOS (5 days vs. 4 days, P<0.0001). Additionally, the study showed IDA patients were found to higher incidence and odds of (73.84% vs. 11.77%, OR 5.04, P<0.0001) 90-day medical complications. IDA patients also incurred high 90-day episode of care costs ($25,597.51 vs. $20,085.70, P<0.0001). Conclusion After adjusting for age, sex, and medical comorbidities this study of over 92,000 patients demonstrated IDA is associated with longer in-hospital LOS, complications, and costs of care. Future studies should compare the duration and severity of IDA on outcomes.
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Affiliation(s)
- Mohamed M Sylla
- State University of New York (SUNY) Downstate College of Medicine, Brooklyn, NY, USA.,Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Lauren Gruffi
- State University of New York (SUNY) Downstate College of Medicine, Brooklyn, NY, USA.,Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Eric S Roth
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Francis E Rosato
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Che Hang Jason Wong
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
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11
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Affiliation(s)
- Patrick Morgan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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12
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Clinical and microbiological features of anaerobic implant-related infection in 80 patients after orthopedic surgery. Anaerobe 2021; 71:102413. [PMID: 34229056 DOI: 10.1016/j.anaerobe.2021.102413] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Implant-related infection is a common complication after orthopedic surgery, but there is limited research focused on anaerobic infections. We retrospectively analyzed data from 80 patients with anaerobic implant-related infections in order to investigate the clinical features, bacterial distribution and antimicrobial resistant characteristics of this disease. METHODS 80 patients who underwent implant-related infections with anaerobes were included. Pathogens were isolated and identified by matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry with verification of 16s rRNA sequencing. Antimicrobial susceptibility testing (AST) was performed using Epsilometric test (E-test). RESULTS Among the 80 patients, 61.2% (49/80) were infected with anaerobes alone, while 38.8% (31/80) were co-infected with anaerobes and other bacteria. Early infection cases involving anaerobe-alone infections were significantly higher compared to the co-infection group (P < 0.001), also exhibiting lower levels of neutrophils (P = 0.033) and ESR (P = 0.046). Anaerobe-alone infections in the prosthetic joint infection group represented a higher proportion compared with other implant-related infections (P = 0.031). Among all species of anaerobes identified, the top 3 were Cutibacterium acnes, Finegoldia magna and Peptostreptococcus anaerobius. Low MIC values to vancomycin was recorded in C. acnes strains and for amoxicillin/clavulanic acid and piperacillin/tazobactam in most F. magna strains. One of the C. acnes and F. magna strains appeared multi-drug resistant except to vancomycin. CONCLUSIONS Anaerobe-alone infections have later first onset times and lower infection biomarker levels compared to co-infected patients. The first choice against C. acnes is vancomycin, while amoxicillin/clavulanic acid and piperacillin/tazobactam are recommended for F. magna.
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Terhune EB, Hannon CP, Burnett RA, Della Valle CJ. Daily Dose of Preoperative Opioid Prescriptions Affects Outcomes After Total Knee Arthroplasty. J Arthroplasty 2021; 36:2302-2306. [PMID: 33526394 DOI: 10.1016/j.arth.2021.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/24/2020] [Accepted: 01/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The use of preoperative opioids is associated with complications after total knee arthroplasty (TKA), but the dosing threshold that constitutes this risk is not known. The purpose of this study was to identify the preoperative daily opioid dose associated with increased complications after primary TKA. METHODS Patients who underwent primary TKA in the Humana claims database (2007-2016) with an opioid prescription within 3 months before surgery were identified. All opioids prescribed within 3 months before TKA were converted to milligram morphine equivalents. Patients were stratified based on daily opioid dose: tier 1) <10, tier 2) 10-25, tier 3) 25-50, tier 4) >50 milligram morphine equivalents. Patients were matched to opioid-naïve patients by comorbidities, age, and gender. Emergency department (ED) visits, readmissions, and surgical complications were compared. RESULTS A total of 20,019 patients using preoperative opioids were identified and matched. ED visits and readmissions within 90 days were significantly higher in opioid users in all tiers (relative risk (RR) of ED visit: 1.25, 1.28, 1.34, and 1.25, respectively; readmission: 1.13, 1.17, 1.22, and 1.19, respectively). Rates of prosthetic joint infection were increased in opioid users in tiers 2, 3, and 4, and the risk increased in a dose-dependent manner (RR 1.37, 1.39, and 1.50, respectively). Patients in tier 4 had an increased risk of revision surgery (RR 1.44) at 2 years. CONCLUSION Preoperative opioid use is associated with a dose-dependent increase in postoperative complications after TKA. Just two 5mg hydrocodone tablets daily lead to increased ED visits and readmission. Higher doses are associated with an increased risk of prosthetic joint infection and revision surgery.
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Affiliation(s)
- E Bailey Terhune
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | | | - Robert A Burnett
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
| | - Craig J Della Valle
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL
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Singh A, Chan PH, Prentice HA, Rao AG. Postoperative opioid utilization associated with revision risk following primary shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:1034-1041. [PMID: 32871267 DOI: 10.1016/j.jse.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/01/2023]
Abstract
INTRODUCTION With a substantial increase in utilization of primary shoulder arthroplasty, it is important to understand risk factors that may signal early failure and need for revision. Recent studies have reported that sustained postoperative opioid use is associated with a higher revision risk after total hip or knee arthroplasty. In this study, we evaluated postoperative opioid utilization as a risk factor for revision after primary shoulder arthroplasty. METHODS We conducted a cohort study using data from a United States integrated health care system's Shoulder Arthroplasty Registry. Patients who had a primary elective shoulder arthroplasty were identified (2009-2017); those with cancer or who underwent other arthroplasty procedures (either shoulder, hip, or knee) within the preceding year were excluded. Cumulative daily opioid utilization during the first year postoperative, calculated as oral morphine equivalents (OME), was categorized into 3 exposure groups: high user (≥15 mg OME daily), moderate user (<15 mg OME daily), and no opioid use (reference group). The exposure window was stratified into 2 time periods: postoperative days 1-90 and postoperative days 91-360. Multivariable Cox proportional-hazards regression was used to evaluate the association between postoperative opioid use and aseptic revision risk. RESULTS The final study sample included 8325 shoulder arthroplasty procedures. Of these individuals, 3707 (45%) received some opioid within the 1 year before the index procedure. We failed to observe a difference in aseptic revision risk between opioid utilization in the first 90 days postoperatively, regardless of dose. After the first 90 days, a higher revision risk was observed for high opioid users compared with nonusers (hazard ratio = 1.62, 95% confidence interval = 1.10-2.41), and no association was observed for moderate users (hazard ratio = 1.25, 95% confidence interval = 0.82-1.91). CONCLUSIONS We found a positive association between opioid consumption and aseptic revision risk after primary shoulder arthroplasty. This study cannot determine if opioids have a direct physiological cause that increases the risk of revision; rather it is likely that opioid consumption is a marker of chronic pain, poor function, and/or poor coping mechanisms. Further study is needed to determine if programs designed to decrease opioid use may impact revision risk after shoulder arthroplasty.
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Affiliation(s)
- Anshuman Singh
- Department of Orthopaedics, Southern California Permanente Medical Group, San Diego, CA, USA.
| | - Priscilla H Chan
- Surgical Outcomes and Analysis, Kaiser Permanente, San Diego, CA, USA
| | | | - Anita G Rao
- Department of Orthopaedics, Northwest Permanente Medical Group, Portland, OR, USA
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Ardeljan AD, Polisetty TS, Palmer JR, Toma JJ, Vakharia RM, Roche MW. Impact of Postoperative Zolpidem Use on Primary Total Knee Arthroplasty: A Retrospective Matched-Controlled Analysis of a Private Insurance Database. J Arthroplasty 2021; 36:1322-1329. [PMID: 33250327 DOI: 10.1016/j.arth.2020.10.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Zolpidem has gained popularity as a pharmaceutical therapy for insomnia, being the most prescribed hypnotic in the United States today. However, it is associated with increased mortality and morbidity. Literature regarding zolpidem use in the total knee arthroplasty (TKA) population is limited. The aim of the study was to analyze postoperative zolpidem use in the TKA population regarding medical and implant complications, falls, and readmission. METHODS The study group was queried according to zolpidem use. Controls consisted of patients who underwent primary TKA without a history of hypnotic drug use. Study group patients were matched to controls in a 1:5 ratio by demographics and comorbidities. Results yielded 99,178 study participants and 495,795 controls. Primary endpoints included 90-day medical and implant complications, fall risk, and readmission. Chi-squared test was used to compare categorical variables. Multivariate logistic regression was used to calculate odds (OR) for complications, fall risk, and readmission. A P value less than 0.05 was considered statistically significant. RESULTS Study group patients had increased odds of medical complications (OR: 1.76, 95% CI: 1.71-1.82, P < .0001) and implant complications (OR: 1.35, 95% CI: 1.23-1.47, P < .0001) compared to controls. Furthermore, patients in the study group were found to have an increased risk of 90- day falls (OR: 1.16, 95% CI: 1.11-1.21, P < .0001). Readmission was similar to controls (5.10% vs 4.84%, P = .12). CONCLUSION Zolpidem use following primary TKA is associated with the risk of morbidity and falls. The findings are consistent with the literature regarding zolpidem. These findings may affect discussion between orthopedic surgeons and patients in the decision-making process prior to undergoing TKA.
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Affiliation(s)
- Andrew D Ardeljan
- Nova Southeastern College of Osteopathic Medicine, Ft. Lauderdale, FL; Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL
| | - Teja S Polisetty
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL; Harvard Medical School, Harvard University, Boston, MA
| | - Joseph R Palmer
- Department of Orthopaedic Surgery, Broward Health Medical Center, Ft. Lauderdale, FL
| | - Justin J Toma
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL
| | - Rushabh M Vakharia
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL; Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY
| | - Martin W Roche
- Holy Cross Hospital, Orthopaedic Research Institute, Ft. Lauderdale, FL
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Affiliation(s)
- Mengnai Li
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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Vakharia RM, Adams CT, Anoushiravani AA, Ehiorobo JO, Mont MA, Roche MW. Chronic Obstructive Pulmonary Disease Is Associated With Higher Rates of Venous Thromboemboli Following Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:2066-2071.e9. [PMID: 32349891 DOI: 10.1016/j.arth.2020.03.053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/24/2020] [Accepted: 03/31/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is discordance in the literature regarding the presence of chronic obstructive pulmonary disease (COPD) and the development of venous thromboemboli (VTEs). Therefore, the purpose of this study is to determine whether COPD patients undergoing primary total knee arthroplasty (TKA) have higher rates of (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) VTEs; and (4) costs of care. METHODS COPD patients undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, gender, and medical comorbidities. Patients with a history of VTEs or hypercoagulable states were excluded. The query yielded 211,378 patients in the study (n = 35,230) and control (n = 176,148) cohorts. Outcomes analyzed included in-hospital LOS, readmission rates, VTEs, and costs of care. A P-value less than .01 was considered statistically significant. RESULTS COPD patients were found to have significantly longer in-hospital LOS (4 vs 3 days, P < .0001). Study group patients were also found to have significantly higher incidence and odds ratio (OR) of readmission rates (20.9% vs 16.3%; OR 1.36, P < .0001) and VTEs (1.75 vs .93; OR 1.18, P < .0001). Additionally, the study demonstrated that COPD patients incurred higher 90-day episode-of-care costs ($15,626.85 vs $14,471.29, P < .0001). CONCLUSION After adjusting for confounding variables, our study found an association between COPD and higher rates of developing VTEs following primary TKA. The study can be used by orthopedic surgeons to adequately counsel and educate these patients of the potential complications which may arise following their TKA.
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Affiliation(s)
- Rushabh M Vakharia
- Department of Orthopaedic Surgery, Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
| | - Curtis T Adams
- Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | | | - Joseph O Ehiorobo
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York, NY; Department of Orthopaedic Surgery, Cleveland Clinic Hospital, Cleveland, OH
| | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Orthopaedic Research Institute, Fort Lauderdale, FL
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Gold PA, Garbarino LJ, Anis HK, Neufeld EV, Sodhi N, Danoff JR, Boraiah S, Rasquinha VJ, Mont MA. The Cumulative Effect of Substance Abuse Disorders and Depression on Postoperative Complications After Primary Total Knee Arthroplasty. J Arthroplasty 2020; 35:S151-S157. [PMID: 32061474 DOI: 10.1016/j.arth.2020.01.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/06/2020] [Accepted: 01/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Substance abuse disorder (SUD), alcohol abuse disorder (AUD), and depression have been identified as independent risk factors for complications after total knee arthroplasty (TKA). However, these mental health disorders are highly co-associated, and their cumulative effect on postoperative complications have not been investigated. Therefore, this study aimed to determine if patients who have more than one mental health disorder (SUD, AUD, or depression) were at an increased risk for postoperative complications following TKA. METHODS A total of 11,403 TKA patients were identified from a prospectively collected institutional database between January 1, 2017 and April 1, 2019. Patients who had depression, SUD, and AUD were separated into 7 mental health subgroups including each of these diagnoses alone and their combined permeations. Patient demographics, body mass indices, medical comorbidities, and 15 postoperative complications were collected. Univariate analyses were performed using independent Student's t-tests. Multivariate analyses were then performed to identify odds ratios (ORs) for mental health disorders subgroups associated with complications. RESULTS We found a total of 2073 (18%) patients diagnosed with either SUD (4%), AUD (0.6%), or depression (12%). Univariate analyses showed that depression was associated with mechanical failures (P < .001). SUD was associated with periprosthetic joint infection (PJI) (P < .001), wound complications (P = .022), and aseptic loosening (P = .007). AUD was associated with PJI (P < .001) and deep vein thromboses (P = .003). Multivariate analyses found that AUD (OR: 19.419, P < .001) and SUD (OR:3.693, P = .010) were independent risk factors for PJI. Compared with SUD alone, patients with depression plus SUD were found to have a 4-fold (OR: 13.639, P < .001) and 2-fold (OR:4.401, P = .021) increased risk for PJI and cellulitis, respectively. CONCLUSIONS Patients who had depression, SUD, or AUD were at increased risk for postoperative complications following primary TKA. When patients have more than one mental health diagnosis, their risk for complications was amplified. The results of this study can help identify those patients who are at greater risk of postoperative complications to enable improved preoperative optimization and patient education.
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Affiliation(s)
- Peter A Gold
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Luke J Garbarino
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Hiba K Anis
- Department of Orthopedic Surgery, The Cleveland Clinic, Cleveland, OH
| | - Eric V Neufeld
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Nipun Sodhi
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Jonathan R Danoff
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY
| | - Sreevathsa Boraiah
- Department of Orthopedic Surgery, North Shore University Hospital, Manhasset, NY
| | - Vijay J Rasquinha
- Department of Orthopedic Surgery, Long Island Jewish Medical Center, New Hyde Park, NY
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY
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Sodhi N, Anis HK, Acuña AJ, Vakharia RM, Piuzzi NS, Higuera CA, Roche MW, Mont MA. The Effects of Opioid Use on Thromboembolic Complications, Readmission Rates, and 90-Day Episode of Care Costs After Total Hip Arthroplasty. J Arthroplasty 2020; 35:S237-S240. [PMID: 32197965 DOI: 10.1016/j.arth.2020.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether opioid use disorder (OUD) patients are at greater odds than non-opioid use disorder (NUD) patients in developing (1) thromboembolic complications; (2) readmission rates; and (3) costs of care. METHODS All patients with a 90-day history of OUD before total hip arthroplasty (THA) were identified from a national database. Patients were matched 1:5 to controls by age, gender, Elixhauser Comorbidity Index scores, and high-risk medical comorbidities, yielding 38,821 patients with (n = 6398) and without (n = 31,883) OUD. Multivariate logistic regression analyses were performed to compare the risks of developing venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) 90 days after the index procedure, 90-day readmission rates, and total global 90-day episode of care costs. RESULTS Patients with a history of OUD were found to be at greater risk for 90-day venous thromboembolisms (2.38 vs. 1.07%; OR: 2.25, 95% CI: 1.86-2.73, P < .0001) compared with matched NUD patients. Specifically, OUD patients were at greater risk for both deep vein thromboses (2.13 vs. 0.87%; OR: 2.46, 95% CI: 2.00-3.03, P < .001) and pulmonary embolism (0.61 vs. 0.27%; OR: 2.24, 95% CI: 1.53-3.27, P < .0001). In addition, patients with OUD were at an increased risk for 90-day readmission (28.68 vs. 22.62%; OR: 1.37, 95% CI: 1.29-1.46, P < .0001) compared with controls. Primary THA patients with OUD incurred a 14.72% higher cost of care ($20,610.65 vs. $17,964.58) compared with NUD patients. CONCLUSION These findings demonstrate that primary THA patients with a history of OUD are at greater risks for thromboembolic complications, readmissions, and higher costs of care in the 90-day postoperative period.
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Affiliation(s)
- Nipun Sodhi
- Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New York, NY
| | - Hiba K Anis
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Rushabh M Vakharia
- Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH
| | | | - Martin W Roche
- Department of Orthopaedic Surgery, Holy Cross Hospital, Ft. Lauderdale, FL
| | - Michael A Mont
- Department of Orthopaedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY
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20
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Kim SC, Bateman BT. Methodological Challenges in Conducting Large-Scale Real-World Data Analyses on Opioid Use in Musculoskeletal Disorders. J Bone Joint Surg Am 2020; 102 Suppl 1:10-14. [PMID: 32251129 DOI: 10.2106/jbjs.20.00121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Seoyoung C Kim
- Divisions of Pharmacoepidemiology and Pharmacoeconomics (S.C.K. and B.T.B.) and Rheumatology, Inflammation, and Immunity (S.C.K.), and Department of Anesthesiology (B.T.B.), Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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