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Laperche J, Barrett CC, Glasser J, Yang DS, Lemme N, Garcia D, Daniels AH, Antoci V. Chronic obstructive pulmonary disease is an independent risk factor for increased opioid use in total hip arthroplasty: A retrospective PearlDiver study. J Orthop 2023; 46:95-101. [PMID: 37969229 PMCID: PMC10641556 DOI: 10.1016/j.jor.2023.09.010] [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: 07/29/2023] [Revised: 09/07/2023] [Accepted: 09/20/2023] [Indexed: 11/17/2023] Open
Abstract
Background Total hip arthroplasty (THA) has become an incredibly common procedure due to its' predictability and high success rate. The success of surgery is related to strict indications and careful optimization of medical comorbidities to decrease risk and improve outcomes. Chronic obstructive pulmonary disease (COPD) has been associated with increased medical and surgical complications. A regulatory focus on opioid utilization does not usually consider COPD as a risk factor, but limited research exists on the impact of COPD on outcomes and risks after THA. Methods Retrospective all-inclusive database analysis of Medicare patients who had undergone THA between 2007 and 2017 included in the PearlDiver Database were studied. Postoperative opioid usage was examined at 1-, 3-, 6-, and 12 months, along with surgical infection, implant complications, and revisions. Post-operative complications within 30 days, either medical or implant related, were identified. Controlling for comorbidities, age, and sex, odds ratios were calculated using multivariable logistic regression with a significant α value of 0.05. Results COPD patients had significantly higher rates of opioid usage postoperatively. COPD patients also had an increased rate of readmissions, medical/implant complications, and revision surgeries. Discussion This is the only study raising concern regarding opioid use in COPD patients after total hip arthroplasty, which may be critical considering the associated respiratory depression further exacerbating the COPD. Considering the evidence of poor outcomes associated with COPD in arthroplasty, appropriately screening for COPD and counseling or planning for post-operative pain control and complications is paramount.
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Affiliation(s)
| | | | | | - Daniel S. Yang
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Nicholas Lemme
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Dioscaris Garcia
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Alan H. Daniels
- University Orthopedics Inc., East Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
| | - Valentin Antoci
- University Orthopedics Inc., East Providence, RI, USA
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Brown University and Rhode Island Hospital, Department of Orthopaedic Surgery, Providence, RI, USA
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Goh GS, Tarabichi S, Baker CM, Qadiri QS, Austin MS. Should We Aim to Help Patients "Feel Better" or "Feel Good" After Total Hip Arthroplasty? Determining Factors Affecting the Achievement of the Minimal Clinically Important Difference and Patient Acceptable Symptom State. J Arthroplasty 2023; 38:293-299. [PMID: 35964857 DOI: 10.1016/j.arth.2022.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Recent attempts have been made to use preoperative patient-reported outcome measure (PROM) thresholds as prior authorization criteria based on the assumption that patients who have higher baseline scores are less likely to achieve the minimal clinically important difference (MCID). This study aimed to identify factors affecting the achievement of MCID and patient acceptable symptom state (PASS) after total hip arthroplasty (THA), and to determine the overlap between the two outcomes. METHODS We identified 3,581 primary, unilateral THAs performed at a single practice in 2015-2019. PROMs including Hip Disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS-JR) and 12-item Short Form Health Survey were collected preoperatively and 1-year postoperatively. The likelihood of attaining PASS according to attainment of MCID was assessed. Multivariable regression was used to identify independent predictors of MCID and PASS. RESULTS In total, 79.8% achieved MCID and 73.6% achieved PASS for HOOS-JR. Approximately 1 in 7 patients who achieved MCID did not eventually achieve PASS. Worse preoperative HOOS-JR (odd ratio 0.933) was associated with MCID attainment. Better preoperative HOOS-JR (odd ratio 1.015) was associated with PASS attainment. Men, lower body mass index, better American Society of Anesthesiologists score, and better preoperative 12-item Short Form Health Survey mental score were predictors of MCID and PASS. Age, race, ethnicity, Charlson Comorbidity Index, and smoking status were not significant predictors. CONCLUSION Preoperative PROMs were associated with achieving MCID and PASS after THA, albeit in opposite directions. Clinicians should strive to help patients "feel better" and "feel good" after surgery. Preoperative PROMs should not solely be used to prioritize access to care.
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Affiliation(s)
- Graham S Goh
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Saad Tarabichi
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Colin M Baker
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Qudratullah S Qadiri
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Matthew S Austin
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Butterly EW, Hanlon P, Shah ASV, Hannigan LJ, McIntosh E, Lewsey J, Wild SH, Guthrie B, Mair FS, Kent DM, Dias S, Welton NJ, McAllister DA. Comorbidity and health-related quality of life in people with a chronic medical condition in randomised clinical trials: An individual participant data meta-analysis. PLoS Med 2023; 20:e1004154. [PMID: 36649256 PMCID: PMC9844862 DOI: 10.1371/journal.pmed.1004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/09/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Health-related quality of life metrics evaluate treatments in ways that matter to patients, so are often included in randomised clinical trials (hereafter trials). Multimorbidity, where individuals have 2 or more conditions, is negatively associated with quality of life. However, whether multimorbidity predicts change over time or modifies treatment effects for quality of life is unknown. Therefore, clinicians and guideline developers are uncertain about the applicability of trial findings to people with multimorbidity. We examined whether comorbidity count (higher counts indicating greater multimorbidity) (i) is associated with quality of life at baseline; (ii) predicts change in quality of life over time; and/or (iii) modifies treatment effects on quality of life. METHODS AND FINDINGS Included trials were registered on the United States trials registry for selected index medical conditions and drug classes, phase 2/3, 3 or 4, had ≥300 participants, a nonrestrictive upper age limit, and were available on 1 of 2 trial repositories on 21 November 2016 and 18 May 2018, respectively. Of 124 meeting these criteria, 56 trials (33,421 participants, 16 index conditions, and 23 drug classes) collected a generic quality of life outcome measure (35 EuroQol-5 dimension (EQ-5D), 31 36-item short form survey (SF-36) with 10 collecting both). Blinding and completeness of follow up were examined for each trial. Using trials where individual participant data (IPD) was available from 2 repositories, a comorbidity count was calculated from medical history and/or prescriptions data. Linear regressions were fitted for the association between comorbidity count and (i) quality of life at baseline; (ii) change in quality of life during trial follow up; and (iii) treatment effects on quality of life. These results were then combined in Bayesian linear models. Posterior samples were summarised via the mean, 2.5th and 97.5th percentiles as credible intervals (95% CI) and via the proportion with values less than 0 as the probability (PBayes) of a negative association. All results are in standardised units (obtained by dividing the EQ-5D/SF-36 estimates by published population standard deviations). Per additional comorbidity, adjusting for age and sex, across all index conditions and treatment comparisons, comorbidity count was associated with lower quality of life at baseline and with a decline in quality of life over time (EQ-5D -0.02 [95% CI -0.03 to -0.01], PBayes > 0.999). Associations were similar, but with wider 95% CIs crossing the null for SF-36-PCS and SF-36-MCS (-0.05 [-0.10 to 0.01], PBayes = 0.956 and -0.05 [-0.10 to 0.01], PBayes = 0.966, respectively). Importantly, there was no evidence of any interaction between comorbidity count and treatment efficacy for either EQ-5D or SF-36 (EQ-5D -0.0035 [95% CI -0.0153 to -0.0065], PBayes = 0.746; SF-36-MCS (-0.0111 [95% CI -0.0647 to 0.0416], PBayes = 0.70 and SF-36-PCS -0.0092 [95% CI -0.0758 to 0.0476], PBayes = 0.631. CONCLUSIONS Treatment effects on quality of life did not differ by multimorbidity (measured via a comorbidity count) at baseline-for the medical conditions studied, types and severity of comorbidities and level of quality of life at baseline, suggesting that evidence from clinical trials is likely to be applicable to settings with (at least modestly) higher levels of comorbidity. TRIAL REGISTRATION A prespecified protocol was registered on PROSPERO (CRD42018048202).
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Affiliation(s)
- Elaine W. Butterly
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Peter Hanlon
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anoop S. V. Shah
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laurie J. Hannigan
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Emma McIntosh
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jim Lewsey
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sarah H. Wild
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Frances S. Mair
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David M. Kent
- Predictive Analytics and Comparative Effectiveness Center, Tufts Medical Center/Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Nicky J. Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David A. McAllister
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Development of Osteopenia During Distal Radius Fracture Recovery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:315-319. [DOI: 10.1016/j.jhsg.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/01/2022] [Indexed: 11/20/2022] Open
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Lan P, Chen X, Fang Z, Zhang J, Liu S, Liu Y. Effects of Comorbidities on Pain and Function After Total Hip Arthroplasty. Front Surg 2022; 9:829303. [PMID: 35647007 PMCID: PMC9130629 DOI: 10.3389/fsurg.2022.829303] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe growing number of patients undergoing total hip arthroplasty (THA) and postoperative outcomes receive increasing attention from doctors and patients. This study aimed to elucidate the effects of comorbidities on postoperative function, pain, complications, readmission rate, and mortality.MethodsWe included consecutive patients who underwent primary unilateral THA between 2017 and 2019. The Charlson comorbidity index (CCI) and the WOMAC and SF-36 (physical function, body pain) scales were assessed preoperatively and at 3, 6, 12, and 24 months postoperatively. The complications, 30-day readmission, and mortality rates assessed the impact of comorbidities and their changes over time on the WOMAC and SF-36 scores during follow-up. We used mixed model linear regression to examine the association of worsening comorbidity post-THA with change in WOMAC and SF-36 scores in the subsequent follow-up periods, controlling for age, length of follow-up, and repeated observations.ResultsThis study included 468 patients, divided into four groups based on comorbidity burden (CCI-0, 1, 2, and ≥3). The physiological function recovery and pain scores in the CCI ≥ 3 group were inferior to the other groups and took longer than the other groups (6 vs. 3 months) to reach their best level. The four groups preoperative waiting times were 2.41 ± 0.74, 2.97 ± 0.65, 3.80 ± 0.53, and 5.01 ± 0.71 days, respectively. The complications, 30-day readmission, and 1-year mortality rates for the overall and the CCI ≥ 3 group were 1.92% and 4.69%, 0.85% and 2.01%, and 0.43% and 1.34%, respectively, with no mortality in the other groups.ConclusionPatients with higher CCI were more susceptible to physical function and pain outcome deterioration, experienced longer waiting time before surgery, took longer to recover, and had higher rates of complications, 30-day readmission, and mortality after THA. Older age in the group led to a greater impact.
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Yayac M, D'Antonio N, Star AM, Austin MS, Courtney PM. Demand Matching and Site of Care: High-Cost Facilities Do Not Improve Short-term Quality Metrics Following Total Hip and Knee Arthroplasty. Orthopedics 2022; 45:19-24. [PMID: 34846241 DOI: 10.3928/01477447-20211124-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
With increased emphasis on improving value in total hip arthroplasty (THA) and total knee arthroplasty (TKA) care, concerns exist about whether variability in hospital costs between facilities is justified. The purpose of this study was to compare index facility reimbursement among hospitals and short-term outcomes for patients undergoing primary THA and TKA. We queried a single private insurer's claims data, identifying all patients undergoing THA or TKA from 2015 to 2017 performed by 25 surgeons across 16 hospitals within our institution. Hospitals were divided into high- and low-cost facilities based on mean index reimbursement. We compared comorbidities, episode-of-care costs, and short-term outcomes between facilities and performed multivariate analyses. Of 2963 procedures, 1305 (44%) were performed at higher-cost hospitals. Higher-cost facilities had higher mean index reimbursement ($40,597 vs $26,781, P<.0001) and higher mean Charlson Comorbidity Index (CCI; 0.32 vs 0.24, P=.0029), but no difference in complications (2.2% vs 1.8%, P=.3955) or readmissions (2.2% vs 1.5%, P=.1490). On multivariate analyses, higher-cost facility increased index reimbursement by $13,780 (95% CI, $13,489-$14,071, P<.0001) and discharge to facility risk (odds ratio [OR], 3.2; 95% CI, 1.9-5.4; P<.0001), but not complication (OR, 1.2; 95% CI, 0.7-2.0; P=.5983) or readmission (OR, 1.5; 95% CI, 0.9-2.6; P=.1474) risks. Shifting 25% of patients with a CCI of 0 from higher- to lower-cost centers would have decreased inpatient facility costs by an estimated $3,582,784. Wide variability exists between hospital facility costs for THA and TKA without differences in short-term outcomes. Demand matching healthier patients to lower-cost facilities may significantly lower the overall procedural costs of THA and TKA. [Orthopedics. 2022;45(1):19-24.].
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Ferguson R, Prieto-Alhambra D, Peat G, Delmestri A, Jordan KP, Strauss VY, Valderas JM, Walker C, Yu D, Glyn-Jones S, Silman A. Does pre-existing morbidity influences risks and benefits of total hip replacement for osteoarthritis: a prospective study of 6682 patients from linked national datasets in England. BMJ Open 2021; 11:e046712. [PMID: 34556506 PMCID: PMC8461685 DOI: 10.1136/bmjopen-2020-046712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Total hip arthroplasty (THA) surgery for elderly people with multimorbidity increases the risk of serious health hazards including mortality. Whether such background morbidity reduces the clinical benefit is less clear. OBJECTIVE To evaluate how pre-existing health status, using multiple approaches, influences risks of, and quality of life benefits from, THA. SETTING Longitudinal record linkage study of a UK sample linking their primary care to their secondary care records. PARTICIPANTS A total of 6682 patients were included, based on the recording of the diagnosis of hip osteoarthritis in a national primary care register and the recording of the receipt of THA in a national secondary care register.Data were extracted from the primary care register on background health and morbidity status using five different constructs: Charlson Comorbidity Index, Electronic Frailty Index (eFI) and counts of comorbidity disorders (from list of 17), prescribed medications and number of primary care visits prior to recording of THA. OUTCOME MEASURES (1) Postoperative complications and mortality; (2) postoperative hip pain and function using the Oxford Hip Score (OHS) and health-related quality of life using the EuroQoL (EQ)-5D score. RESULTS Perioperative complication rate was 3.2% and mortality was 0.9%, both increased with worse preoperative health status although this relationship varied depending on the morbidity construct: the eFI showing the strongest relationship but number of visits having no predictive value. By contrast, the benefits were not reduced in those with worse preoperative health, and improvement in both OHS and EQ-5D was observed in all the morbidity categories. CONCLUSIONS Independent of preoperative morbidity, THA leads to similar substantial improvements in quality of life. These are offset by an increase in medical complications in some subgroups of patients with high morbidity, depending on the definition used. For most elderly people, their other health disorders should not be a barrier for THA.
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Affiliation(s)
- Rory Ferguson
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - George Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Kelvin P Jordan
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Vicky Y Strauss
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jose Maria Valderas
- Health Services and Policy Research Group, Medical School, University of Exeter, Exeter, UK
| | - Christine Walker
- Research User Group, Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Dahai Yu
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alan Silman
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Pulik Ł, Podgajny M, Kaczyński W, Sarzyńska S, Łęgosz P. The Update on Instruments Used for Evaluation of Comorbidities in Total Hip Arthroplasty. Indian J Orthop 2021; 55:823-838. [PMID: 34188772 PMCID: PMC8192606 DOI: 10.1007/s43465-021-00357-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/08/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION It is a well-established fact that concomitant diseases can affect the outcome of total hip arthroplasty (THA). Therefore, careful preoperative assessment of a patient's comorbidity burden is a necessity, and it should be a part of routine screening as THA is associated with a significant number of complications. To measure the multimorbidity, dedicated clinical tools are used. METHODS The article is a systematic review of instruments used to evaluate comorbidities in THA studies. To create a list of available instruments for assessing patient's comorbidities, the search of medical databases (PubMed, Web of Science, Embase) for indices with proven impact on revision risk, adverse events, mortality, or patient's physical functioning was performed by two independent researchers. RESULTS The initial search led to identifying 564 articles from which 26 were included in this review. The measurement tools used were: The Charlson Comorbidity Index (18/26), Society of Anesthesiology classification (10/26), Elixhauser Comorbidity Method (6/26), and modified Frailty Index (5/26). The following outcomes were measured: quality of life and physical function (8/26), complications (10/26), mortality (8/26), length of stay (6/26), readmission (5/26), reoperation (2/26), satisfaction (2/26), blood transfusion (2/26), surgery delay or cancelation (1/26), cost of care (1/26), risk of falls (1/26), and use of painkillers (1/26). Further research resulted in a comprehensive list of eleven indices suitable for use in THA outcomes studies. CONCLUSION The comorbidity assessment tools used in THA studies present a high heterogeneity level, and there is no particular system that has been uniformly adopted. This review can serve as a help and an essential guide for researchers in the field.
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Affiliation(s)
- Łukasz Pulik
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland
| | - Michał Podgajny
- Student Scientific Association of Reconstructive and Oncology Orthopedics of the Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Wiktor Kaczyński
- Student Scientific Association of Reconstructive and Oncology Orthopedics of the Department of Orthopedics and Traumatology, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Sarzyńska
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland
| | - Paweł Łęgosz
- Department of Orthopedics and Traumatology, Medical University of Warsaw, Lindley 4 St, 02-005 Warsaw, Poland
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Mannion AF, Nauer S, Arsoy D, Impellizzeri FM, Leunig M. The Association Between Comorbidity and the Risks and Early Benefits of Total Hip Arthroplasty for Hip Osteoarthritis. J Arthroplasty 2020; 35:2480-2487. [PMID: 32466998 DOI: 10.1016/j.arth.2020.04.090] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The changing demographics of our society will lead to an increasing number of patients presenting for orthopedic surgery with increasing comorbidity. We investigated the association between comorbidity and both the risks (complications) and benefits (improved function) of total hip arthroplasty (THA) for primary hip osteoarthritis, whilst controlling for potential confounders including age. METHODS One thousand five hundred and eighty-four patients (67.1 ± 10.6 years; 54% men) in our tertiary care orthopedic hospital completed the Oxford Hip Score before and 12 months after THA. Comorbidity was assessed using the American Society of Anesthesiologists (ASA) grade and Charlson Comorbidity Index (CCI). Details regarding perioperative complications (hospital stay plus 18 days after discharge; mean 27 ± 3 days) were extracted from the clinic information system and graded for severity. RESULTS For ASA1, 2, and ≥3, respectively, there were 3.1%, 3.0%, and 6.6% surgical/orthopedic complications; 3.7%, 12.5%, and 27.4% general medical complications; and 6.7%, 14.5%, and 29.8% complications of either type. ASA was associated with complication severity (P < .001). In multiple regression, increasing ASA grade (OR 1.74; 95% CI, 1.33-2.29) and age (OR 1.06; 95% CI, 1.05-1.08), both showed an independent association with increased risk of a complication; CCI explained no further significant variance. CCI, but not age, was associated with the 12-month Oxford Hip Score (beta coefficient, -0.742; 95% CI, -1.130 to -0.355; P = .002) while ASA grade explained no further variance. CONCLUSION Greater comorbidity was associated with increased odds of a complication and (independently) slightly worse patient-rated outcome 12 months after THA. Comorbidity indices can be easily obtained for all surgical patients and may assist with preoperative counseling regarding individual risks and benefits of THA.
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Affiliation(s)
- Anne F Mannion
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Selina Nauer
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Diren Arsoy
- Department Hip Surgery, Schulthess Klinik, Zürich, Switzerland
| | - Franco M Impellizzeri
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Michael Leunig
- Department Hip Surgery, Schulthess Klinik, Zürich, Switzerland
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Snell DL, Dunn JA, Jerram KAS, Hsieh CJ, DeJong G, Hooper GJ. Associations between comorbidity and quality of life outcomes after total joint replacement. Qual Life Res 2020; 30:137-144. [PMID: 32816223 DOI: 10.1007/s11136-020-02610-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE We examined associations between self-reported and clinician-assessed comorbidity and quality of life (QOL) outcomes after hip and knee replacement. METHODS This is a cross-sectional, questionnaire-based national survey. Participants aged 45 years or older (n = 409) were recruited from the New Zealand Joint Registry six months after a total hip (THR), total knee (TKR) or unicompartmental knee replacement (UKR). The main outcome QOL was measured using an 8-item short form of the World Health Organisation Quality of Life (WHOQOL-Bref) questionnaire six months following joint replacement surgery. The WHOQOL is a generic and non-health condition specific measure of QOL. RESULTS Participants were on average 68 years of age, with more men (54%) than women (46%). Number of coexisting conditions and body mass index were correlated with age, pain and function scores, and QOL (p < 0.01), but not with each other. Linear regression analyses showed that comorbidities such as number of comorbid conditions and BMI had moderate associations with QOL outcomes. CONCLUSION This study showed that general QOL outcomes following hip and knee joint replacement, while generally high, were associated with comorbidity burden and BMI. Future prospective research examining change in QOL before and following surgery would help to advance understandings of the various factors that contribute to patient satisfaction with their joint replacement.
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Affiliation(s)
- Deborah L Snell
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
| | - Jennifer A Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | | | - C Jean Hsieh
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Gerben DeJong
- Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC, USA
- MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Gary J Hooper
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
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