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Lim PL, Goh GS, Bedair HS, Melnic CM. Weighing the Impact: The Influence of Body Mass Index on Facility Costs in Total Joint Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00625-9. [PMID: 38889808 DOI: 10.1016/j.arth.2024.06.026] [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: 02/07/2024] [Revised: 06/09/2024] [Accepted: 06/11/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Using time-driven activity-based costing (TDABC), a novel cost calculation method that more accurately reflects true resource utilization in health care, we sought to compare the total facility costs across different body mass index (BMI) groups following total joint arthroplasty (TJA). METHODS The study consisted of 13,806 TJAs (7,340 total knee arthroplasties [TKAs] and 6,466 total hip arthroplasties [THAs]) performed between 2019 and 2023. The TDABC data from an analytics platform was employed to depict total facility costs, comprising personnel and supply costs. For the analysis, patients were stratified into four BMI categories: <30, 30 to <35, 35 to <40, and ≥40. Multivariable regression was used to determine the independent effect of BMI on facility costs. RESULTS When indexed to patients who had BMI <30, elevated BMI categories (30 to <35, 35 to <40, and ≥40) were associated with higher total personnel costs (TKA 1.03x versus 1.07x versus 1.13x, P < .001; THA 1.00x versus 1.08x versus 1.08x, P < .001), and total supply costs (TKA 1.01x versus 1.04x versus 1.04x, P < .001; THA 1.01x versus 1.02x versus 1.03x, P = .007). Total facility costs in TJAs were significantly greater in higher BMI categories (TKA 1.02x versus 1.05x versus 1.08x, P < .001; THA 1.01x versus 1.05x versus 1.05x, P < .001). Notably, when incorporating adjustments for demographics and comorbidities, BMI values of 35, 40, and 45 relative to BMI of 25, exhibit a significant association with a 2, 3, and 5% increase in total facility cost for TKAs and a 3, 5, and 7% increase for THAs. CONCLUSIONS Using TDABC methodology, this study found that overall facility costs of TJAs increase with BMI. The present study provides patient-level cost insights, indicating the potential need for reassessment of physician compensation models in this population. Further studies may facilitate the development of risk-adjusted procedural codes and compensation models for public and private payors. LEVEL OF EVIDENCE Level IV, economic and decision analyses.
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Affiliation(s)
- Perry L Lim
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Graham S Goh
- Department of Orthopaedic Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Hany S Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Christopher M Melnic
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Huffman N, Pasqualini I, Redfern RE, Murray TG, Deren ME, Israelite CL, Nelson CL, Van Andel D, Cholewa JM, Anderson MB, Klika AK, McLaughlin JP, Piuzzi NS. Patient satisfaction and patient-reported outcomes do not vary by BMI class in total hip arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1979-1985. [PMID: 38488936 PMCID: PMC11101366 DOI: 10.1007/s00590-024-03894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Obesity has been identified as a risk factor for postoperative complications in patients undergoing total hip arthroplasty (THA). This study aimed to investigate patient-reported outcomes, pain, and satisfaction as a function of body mass index (BMI) class in patients undergoing THA. METHODS 1736 patients within a prospective observational study were categorized into BMI classes. Pre- and postoperative Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS JR), satisfaction, and pain scores were compared by BMI class using one-way ANOVA. RESULTS Healthy weight patients reported the highest preoperative HOOS JR (56.66 ± 13.35) compared to 45.51 ± 14.45 in Class III subjects. Healthy weight and Class III patients reported the lowest (5.65 ± 2.01) and highest (7.06 ± 1.98, p < 0.0001) preoperative pain, respectively. Changes in HOOS JR scores from baseline suggest larger improvements with increasing BMI class, where Class III patients reported an increase of 33.7 ± 15.6 points at 90 days compared to 26.1 ± 17.1 in healthy weight individuals (p = 0.002). Fewer healthy weight patients achieved the minimal clinically important difference (87.4%) for HOOS JR compared to Class II (96.5%) and III (94.7%) obesity groups at 90 days postoperatively. Changes in satisfaction and pain scores were largest in the Class III patients. Overall, no functional outcomes varied by BMI class postoperatively. CONCLUSION Patients of higher BMI class reported greater improvements following THA. While risk/benefit shared decision-making remains a personalized requirement of THA, this study highlights that utilization of BMI cutoff may not be warranted based on pain and functional improvement.
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Affiliation(s)
- Nickelas Huffman
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA
| | - Ignacio Pasqualini
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA
| | | | - Trevor G Murray
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA
| | - Matthew E Deren
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA
| | - Craig L Israelite
- Department of Orthopaedic Surgery, Penn Medicine, Philadelphia, PA, 19104, USA
| | - Charles L Nelson
- Department of Orthopaedic Surgery, Penn Medicine, Philadelphia, PA, 19104, USA
| | | | | | | | - Alison K Klika
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA
| | - John P McLaughlin
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA
| | - Nicolas S Piuzzi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Orthopedic and Rheumatology Institute, Cleveland, OH, 44195, USA.
- Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA.
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Tidd JL, Rullán PJ, Oyem PC, Hadad MJ, Pasqualini I, Huffman N, Klika AK, Piuzzi NS. Does Your Patient Need to Lose Weight? Weight Change Before and After Total Hip Arthroplasty Does Not Affect Health Care Utilization and Achievement of the Minimal Clinically Important Difference. J Arthroplasty 2024:S0883-5403(24)00170-0. [PMID: 38403079 DOI: 10.1016/j.arth.2024.02.051] [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: 10/24/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Despite the potential negative impact of preoperative obesity on total hip arthroplasty (THA) outcomes, the association between preoperative and postoperative weight change and outcomes is much less understood. Therefore, this study aimed to determine the impact of preoperative and postoperative weight change and preoperative body mass index (BMI) on health care utilization, satisfaction, and achievement of minimal clinically important difference (MCID) for Hip Disability and Osteoarthritis Outcome Score Physical Function Short-Form (HOOS PS) and HOOS Pain. METHODS Patients who underwent primary elective unilateral THA between January 2016 and December 2019 were included (N = 2,868). Multivariable logistic regression assessed the association between BMI and preoperative and postoperative weight change on outcomes while controlling for demographic characteristics. RESULTS There was no association between preoperative weight change and prolonged length of stay (> 3 days), 90-day readmission, nonhome discharge, patient dissatisfaction at 1 year, or achievement of HOOS Pain or HOOS PS MCID. Postoperative weight loss was an independent risk factor for patient dissatisfaction at 1 year but was not associated with achievement of either HOOS Pain or HOOS PS MCID at 1-year postoperative. Preoperative obesity classes I to III were independent risk factors for nonhome discharge. Nevertheless, preoperative obesity class I and class II were associated with an increased probability of reaching HOOS Pain MCID. Preoperative BMI was not associated with an increased risk of patient dissatisfaction. CONCLUSIONS Preoperative weight change does not appear to influence health care utilization, satisfaction, or achievement of MCID in pain and function following THA. Postoperative weight loss may play a role as a risk factor for dissatisfaction following THA. Additionally, patients who had a higher baseline BMI may be more likely to see improvement in pain following THA. Therefore, when counseling obese patients for THA, surgeons must balance the risk of perioperative complications with the expectation of greater improvements in pain.
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Affiliation(s)
- Joshua L Tidd
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio
| | - Pedro J Rullán
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Precious C Oyem
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Matthew J Hadad
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Nickelas Huffman
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Alison K Klika
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Zgouridou A, Kenanidis E, Potoupnis M, Tsiridis E. Global mapping of institutional and hospital-based (Level II-IV) arthroplasty registries: a scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1219-1251. [PMID: 37768398 PMCID: PMC10858160 DOI: 10.1007/s00590-023-03691-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/13/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE Four joint arthroplasty registries (JARs) levels exist based on the recorded data type. Level I JARs are national registries that record primary data. Hospital or institutional JARs (Level II-IV) document further data (patient-reported outcomes, demographic, radiographic). A worldwide list of Level II-IV JARs must be created to effectively assess and categorize these data. METHODS Our study is a systematic scoping review that followed the PRISMA guidelines and included 648 studies. Based on their publications, the study aimed to map the existing Level II-IV JARs worldwide. The secondary aim was to record their lifetime, publications' number and frequency and recognise differences with national JARs. RESULTS One hundred five Level II-IV JARs were identified. Forty-eight hospital-based, 45 institutional, and 12 regional JARs. Fifty JARs were found in America, 39 in Europe, nine in Asia, six in Oceania and one in Africa. They have published 485 cohorts, 91 case-series, 49 case-control, nine cross-sectional studies, eight registry protocols and six randomized trials. Most cohort studies were retrospective. Twenty-three per cent of papers studied patient-reported outcomes, 21.45% surgical complications, 13.73% postoperative clinical and 5.25% radiographic outcomes, and 11.88% were survival analyses. Forty-four JARs have published only one paper. Level I JARs primarily publish implant revision risk annual reports, while Level IV JARs collect comprehensive data to conduct retrospective cohort studies. CONCLUSIONS This is the first study mapping all Level II-IV JARs worldwide. Most JARs are found in Europe and America, reporting on retrospective cohorts, but only a few report on studies systematically.
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Affiliation(s)
- Aikaterini Zgouridou
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece.
| | - Michael Potoupnis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, Greece
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Muthusamy N, Christensen T, Singh V, Sicat CS, Rozell JC, Schwarzkopf R, Lajam CM. Trends of obesity rates between primary total hip arthroplasty patients and the general population from 2013 to 2020. ARTHROPLASTY 2022; 4:38. [PMID: 36071492 PMCID: PMC9454112 DOI: 10.1186/s42836-022-00140-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The prevalence of obesity in total hip arthroplasty (THA) patients has been studied in the past. However, there has not been direct comparison against obesity in the general population. This study compared yearly trends in BMI and obesity rates between patients who had undergone primary THA and those from the general patient population. Methods We retrospectively reviewed all patients over the age of 18 who underwent primary, elective THA and those who had an annual routine physical exam between January 2013 and December 2020 at our academic tertiary medical center. Baseline demographics were controlled in our statistical models. Significance of yearly trends was determined through a linear regression analysis. Independent samples t-test and Chi-square test were used to compare means and proportions between the two groups, respectively. Results A total of 11,250 primary THA patients and 1,039,918 annual physical exam patients were included. Average BMI for the THA group was significantly higher (P < 0.001) each year compared to the annual physicals group (APG). Higher obesity rates were observed in all obesity subgroups (all classes, and class I–III individually) for THA patients each year compared to the APG. Interestingly, while we found a significantly increasing trend in obesity for the general population (P < 0.001), BMI and obesity rates remained stable in the THA population. Conclusion While our general patient population showed significant increase in BMI and obesity over time, THA patients had higher, yet stable, BMI. Further investigation is required to determine the role of risk optimization in these findings. Level III Evidence Retrospective Cohort Study.
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Downey C, John KS, Chatterji J, Cassar-Gheiti A, O'Byrne JM, Kenny P, Cashman JP. Obesity trends over 10 years in primary hip and knee arthroplasty-a study of 12,000 patients. Ir J Med Sci 2022:10.1007/s11845-022-03092-w. [PMID: 35798996 DOI: 10.1007/s11845-022-03092-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/30/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/AIMS Obesity and its increasing prevalence are global public health concerns. Following joint replacement, there is evidence to support that obese patients are more likely to suffer complications. We examined 10-year trends in BMI of the primary total hip and total knee replacement cohorts in our institution to discern whether the BMI of these patients has changed over time. METHODS We examined BMI data of patients who underwent primary hip and knee arthroplasty from our institutional database from January 1, 2010 to December 31, 2019 (n = 12,169). We analysed trends in BMI over this period with respect to (i) surgical procedure, (ii) gender, and (iii) age categories. RESULTS The overall number of surgical procedures increased over the study period which meant more obese patients underwent surgery over time. Average BMI did not change significantly over time; however, there was a statistically significant increase in BMI in females aged < 45 in both arthroplasty groups. CONCLUSION The average BMI of patients undergoing primary hip and knee arthroplasty in our high-volume tertiary orthopaedic centre has remained relatively unchanged over the past 10 years; however, our local service is caring for a greater number of overweight/obese patients due to the increase in overall volume. This will have significant implications on health care expenditure and infrastructure going forward which further emphasises the importance of ongoing national obesity prevention strategies. The increase in BMI seen in females aged < 45 may mark an impending era of obese younger patients with end-stage osteoarthritis.
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Affiliation(s)
- Colum Downey
- National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Dublin, Ireland.
| | - Katie St John
- Connolly Hospital Blanchardstown, Dublin 15, Dublin, Ireland
| | - Jeet Chatterji
- National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Dublin, Ireland
| | | | - John M O'Byrne
- National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Dublin, Ireland
| | - Paddy Kenny
- National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Dublin, Ireland
| | - James P Cashman
- National Orthopaedic Hospital Cappagh, Finglas, Dublin 11, Dublin, Ireland
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Machine Learning Model Identifies Increased Operative Time and Greater BMI as Predictors for Overnight Admission After Outpatient Hip Arthroscopy. Arthrosc Sports Med Rehabil 2022; 3:e1981-e1990. [PMID: 34977657 PMCID: PMC8689272 DOI: 10.1016/j.asmr.2021.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/06/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose The purposes of this study were to identify patient characteristics and risk factors for overnight admission following outpatient hip arthroscopy and to develop a machine learning algorithm that can effectively identify patients requiring admission following elective hip arthroscopy. Methods A retrospective review of a prospectively collected national surgical outcomes database was performed to identify patients who underwent elective outpatient hip arthroscopy from 2006 to 2018. Patients admitted overnight postoperatively were identified as those with length of stay of 1 or more days. Models were generated using random forest (RF), extreme gradient boosting (XGBoost), adaptive boosting (AdaBoost), elastic net penalized logistic regression, and an additional model was produced as a weighted ensemble of the four final algorithms. Results Overall, 1,276 patients were included. The median age was 43 years, and 64.2% (819) were female. Of the included patients, 109 (8.5%) required an overnight stay following elective outpatient hip arthroscopy. The most important factors for inpatient admission were increasing operative time, general anesthesia, age extremes, male gender, greater body mass index (BMI), American Society of Anesthesiologists classification >1, and the following preoperative lab values outside of normal ranges: sodium, platelet count, hematocrit, and leukocyte count. The ensemble model achieved the best performance based on discrimination assessed via internal validation (area under the curve = .71), calibration, and decision curve analysis. The model was integrated into a Web-based open-access application able to provide both personalized predictions and explanations. Conclusion A machine learning algorithm developed based on preoperative features identified increasing operative time, age extremes, greater BMI, sodium, hematocrit, platelets, and leukocyte count as the most important variables associated with inpatient admission with fair validity.
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Affiliation(s)
- Patrick Morgan
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
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