RESUMO
Rural patients have poorer health indicators, including higher risk of developing osteoarthritis. The objective of this study is to compare rural patients undergoing primary total joint arthroplasty (TJA) at rural hospitals with those undergoing primary TJA at urban hospitals with regards to demographics, comorbidities, and complications and to determine the preferred location of care for rural patients. Data from the Healthcare Cost and Utilization Project National Inpatient Sample between 2016 and 2018 were analyzed. Demographics, comorbidities, inpatient complications, hospital length of stay, inpatient mortality, and discharge disposition were compared between rural patients who underwent TJA at rural hospitals and urban hospitals. Rural patients undergoing primary TJA in rural hospitals were more likely to be women, to be treated in the South, to have Medicaid payer status, to have dementia, diabetes mellitus, lung disease, and postoperative pulmonary complications, and to have a longer hospital length of stay. Those patients were also less likely to have baseline obesity, heart disease, kidney disease, liver disease, cancer, postoperative infection, and cardiovascular complications, and were less likely to be discharged home. Rural patients undergoing primary TJA tend to pursue surgery in their rural hospital when their comorbidity profile is manageable. These patients get their surgery performed in an urban setting when they have the means for travel and cost, and when their comorbidity profile is more complicated, requiring more specialized care, Rural patients are choosing to undergo their primary TJA in urban hospitals as opposed to their local rural hospitals. (Journal of Surgical Orthopaedic Advances 33(2):061-067, 2024).
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Artroplastia de Quadril , Artroplastia do Joelho , Tempo de Internação , Humanos , Feminino , Masculino , Artroplastia do Joelho/estatística & dados numéricos , Idoso , Artroplastia de Quadril/estatística & dados numéricos , Pessoa de Meia-Idade , Tempo de Internação/estatística & dados numéricos , Estados Unidos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Hospitais Urbanos/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Comorbidade , População Rural/estatística & dados numéricosRESUMO
PURPOSE: The use of computer-assisted and robotic surgery was developed to improve component position and outcomes of total knee arthroplasty (TKA). The goal of this study is to identify differences in patient demographics, comorbidities, and complications between technology-assisted and conventional TKA. METHODS: A Nationwide Inpatient Sample database was used to identify patients who underwent technology-assisted and conventional TKA from 2016 to 2018. Analysed variables include demographics, length of stay (LOS), payer-status, geographic region, comorbidities, complications, and mortality. Univariate and multivariate analyses were performed to identify differences between both groups. RESULTS: The analysis includes 2,208,434 TKA patients, of which 2,054,879 (93.05%) were conventional and 153,555 (6.95%) were technology assisted. Patients undergoing technology-assisted TKA were more likely to be older than 65 years, had higher median income quartile, and had surgery in urban teaching hospitals. Patients were less likely to undergo technology-assisted TKA if they were female gender, had Medicare payer status, were black race, were obese, were living in rural location, or had higher Charlson comorbidity score and baseline comorbidities. Technology-assisted TKA patients had shorter LOS, and fewer pulmonary and infection complications. CONCLUSION: Patients undergoing technology-assisted TKA are being carefully selected with less baseline comorbidities, improved health, and living in urban areas. Subsequently, those carefully selected patients are discharged home, have a shorted hospital LOS, and have fewer complications compared to conventional TKA. Rural patients, black race and female gender are less likely to undergo technology-assisted TKA, further emphasizing the healthcare disparity for that segment of the population. LEVEL OF EVIDENCE: Therapeutic level III.
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Artroplastia do Joelho , Humanos , Feminino , Idoso , Estados Unidos , Masculino , Artroplastia do Joelho/efeitos adversos , Fatores de Risco , Medicare , Complicações Pós-Operatórias/etiologia , Comorbidade , Tempo de InternaçãoRESUMO
INTRODUCTION: The impact of autoimmune skin disorders on post-operative outcomes after TJA is conflicting and studies are limited by small sample sizes. The purpose of this study is to analyze a range of common autoimmune skin disorders and identify whether an increased risk of post-operative complication exists after total joint arthroplasty. METHODS: Data was collected from NIS database for patients diagnosed with autoimmune skin disorder (psoriasis, lupus, scleroderma, atopic dermatitis) and who underwent total hip arthroplasty (THA), total knee arthroplasty (TKA), or other TJA (shoulder elbow, wrist, ankle) between 2016 and 2019. Demographic, social, and comorbidity data was collected. Multivariate regression analyses were performed to assess the independent influence of autoimmune skin disorder on each post-operative outcome including implant infection, transfusion, revision, length of stay, cost, and mortality. RESULTS: Among 55,755 patients with autoimmune skin disease who underwent TJA, psoriasis was associated with increased risk of periprosthetic joint infection following THA (odds ratio 2.44 [1.89-3.15]) and increased risk of transfusion following TKA (odds ratio 1.33 [1.076-1.64]). Similar analyses were performed for systemic lupus erythematosus, atopic dermatitis, and scleroderma, however no statistically significant associations were observed in any of the six collected post-operative outcomes. CONCLUSION: This study suggests psoriasis is an independent risk factor for poorer post-operative outcomes following total joint arthroplasty, however similar risk was not observed for other autoimmune skin disorders such as lupus, atopic dermatitis, or scleroderma.
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Artroplastia de Quadril , Artroplastia do Joelho , Dermatite Atópica , Psoríase , Dermatopatias , Humanos , Dermatite Atópica/complicações , Dermatite Atópica/epidemiologia , Artroplastia do Joelho/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Artroplastia de Quadril/efeitos adversos , Fatores de Risco , Dermatopatias/complicações , Psoríase/complicações , Estudos RetrospectivosRESUMO
The purpose of the study was to (1) assess the prevalence of comorbidities and (2) compare demographics of surgically and non-surgically treated distal humerus fracture patients. Retrospective review of data from a national database was performed. The primary outcome was comorbidities; the secondary outcome was demographic trends between treatment groups. Distal humerus fractures are associated with cerebrovascular disease, dementia, diabetes mellitus, heart disease, hyperlipidemia, hypertension, hypothyroidism, kidney disease, liver disease, and lung disease. Those undergoing surgery are more likely to be obese, under the age of 40 years, female, Medicare recipients with fewer comorbidities, who reside in a rural setting, and who seek care at urban/teaching hospitals within the Southern United States. They are also more likely to have a shorter hospital stay, to be discharged to home, and to have improved survival. (Journal of Surgical Orthopaedic Advances 32(1):017-022, 2023).
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Fraturas Ósseas , Fraturas Distais do Úmero , Idoso , Humanos , Adulto , Feminino , Estados Unidos/epidemiologia , Medicare , Fraturas Ósseas/cirurgia , Comorbidade , Úmero , Demografia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
This study examines the difference in length of stay and total hospital charge by income quartile in hip fracture patients. The length of stay increased in lower income groups, while total charge demonstrated a U-shaped relationship, with the highest charges in the highest and lowest income quartiles. INTRODUCTION: Socioeconomic factors have an impact on outcomes in hip fracture patients. This study aims to determine if there is a difference in hospital length of stay (LOS) and total hospital charge between income quartiles in hospitalized hip fracture patients. METHODS: National Inpatient Sample (NIS) data from 2016 to 2018 was used to determine differences in LOS, total charge, and other demographic/clinical outcomes by income quartile in patients hospitalized for hip fracture. Multivariate regressions were performed for both LOS and total hospital charge to determine variable impact and significance. RESULTS: There were 860,045 hip fracture patients were included this study. With 222,625 in the lowest income quartile, 234,215 in the second, 215,270 in the third, and 190,395 in the highest income quartile. LOS decreased with increase in income quartile. Total charge was highest in the highest quartile, while it was lowest in the middle two-quartiles. Comorbidities with the largest magnitude of effect on both LOS and total charge were lung disease, kidney disease, and heart disease. Time to surgery post-admission also had a large effect on both outcomes of interest. CONCLUSION: The results demonstrate that income quartile has an effect on both hospital LOS and total charge. This may be the result of differences in demographics and other clinical variables between quartiles and increased comorbidities in lower income levels. The overall summation of these socioeconomic, demographic, and medical factors affecting patients in lower income levels may result in worse outcomes following hip fracture.
Assuntos
Fraturas do Quadril , Preços Hospitalares , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Hospitais , Humanos , Tempo de Internação , Estudos RetrospectivosRESUMO
BACKGROUND: As orthopedic surgeons search for objective measures that predict total joint arthroplasty (TJA) outcomes, body mass index may aid in risk stratification. The purpose of this study was to compare in-hospital TJA outcomes and resource consumption amongst underweight (body mass index ≤19 kg/m(2)) and morbidly obese patients (≥40 kg/m(2)). METHODS: Discharge data from 2006 to 2012 National Inpatient Sample were used for this study. A total of 1503 total hip arthroplasty (THA) and 956 total knee arthroplasty (TKA) patients were divided into 2 cohorts, underweight (≤19 kg/m(2)) and morbidly obese (≥40 kg/m(2)). Patients were matched by gender and 27 comorbidities by use of Elixhauser Comorbidity Index. Patients were compared for 13 in-hospital postoperative complications, length of stay, total hospital charge, and disposition. Multivariate analyses were generated by SAS software. Significance was assigned at P value <.05. RESULTS: Underweight patients undergoing primary TJA had higher risk for developing postoperative anemia compared with morbidly obese patients (TKA: odds ratio [OR], 3.1; 95% CI, 2.3-4.1; THA: OR, 1.8; 95% CI, 1.5-2.3). Underweight THA candidates displayed greater risk for deep venous thrombosis (75.36% vs 24.64%; OR, 3.1; 95% CI, 1.1-8.4). Underweight TJA patients were charged more (TKA: USD 51,368.90 vs USD 40,128.80, P = .001, THA: USD 57,451.8 vs USD 42,776.9, P < .001) compared to the morbidly obese patients. Length of stay was significantly longer for underweight THA patients (4.6 days vs 3.5 days, P = .008) compared to morbidly obese counterparts. CONCLUSION: Our results indicate underweight, compared to morbidly obese, TJA patients are at a greater risk for postoperative anemia and consume more resources.
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Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Recursos em Saúde/estatística & dados numéricos , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/etiologia , Magreza/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anemia/etiologia , Feminino , Hospitais , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Alta do Paciente , Estudos Retrospectivos , Trombose Venosa/etiologia , Adulto JovemRESUMO
BACKGROUND: Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists. METHODS: Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05. RESULTS: Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities. CONCLUSION: Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Estado Nutricional , Complicações Pós-Operatórias/etiologia , Magreza , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Feminino , Recursos em Saúde/estatística & dados numéricos , Hospitais , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Seroma/etiologia , Instituições de Cuidados Especializados de Enfermagem , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Diabetes is known to be associated with poorer perioperative outcomes after hip, knee, and shoulder arthroplasty. This study is the first, to our knowledge, to examine the association between diabetes and in-hospital complications, length of stay, non-homebound discharge, transfusion risk, and total charges after total elbow arthroplasty (TEA). METHODS: By use of International Classification of Diseases, Ninth Revision codes, epidemiologic as well as patient and hospital demographic data for all patients undergoing TEA were extracted from the Nationwide Inpatient Sample from 2007 through 2011. We found 13,698 patients who underwent TEA and subsequently separated them into 2 cohorts, those patients with (16.5%) and without (83.5%) diabetes. Specific outcome measures between the diabetic and nondiabetic cohorts were compared through bivariate and multivariate analyses. RESULTS: Diabetic patients had significantly longer lengths of stay, increased rates of needing a transfusion perioperatively, and higher rates of a number of complications after TEA compared with the nondiabetic group. Significant differences in demographic factors in diabetic patients compared with nondiabetic patients included age, gender, insurance type, and geography. Diabetes was an independent predictor of both prolonged hospital stay and non-homebound discharge after TEA. DISCUSSION: Diabetic patients have significantly higher rates of several perioperative complications, and diabetes is an independent risk factor for prolonged hospital stay, as well as increased risk of non-homebound discharge. Future studies need to further investigate this relationship between diabetes and poorer TEA outcomes.
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Artroplastia de Substituição do Cotovelo , Complicações do Diabetes , Complicações Intraoperatórias , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Avaliação de Resultados em Cuidados de Saúde , Fatores de Risco , Estados UnidosRESUMO
Demand and cost of total knee arthroplasty (TKA) has increased significantly over the past decade resulting in decreased hospital length of stay (LOS) to counterbalance increasing cost of health care. The purpose of this study was to determine the factors that influence LOS following primary TKA. Discharge data from the 2009-2011 Nationwide Inpatient Sample were used. Patients included underwent primary TKA and were grouped based on LOS; 3 days or less, and 4 days or more. Majority of patients had a hospital LOS of 3 or less (74.8%). The most significant predictors of increased hospital LOS (≥ 4 days) were age ≥ 80 years, Hispanic race, Medicaid payer status, lower median household income, weekend admission, rural non-teaching hospital, discharge to another facility and any complication.
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Artroplastia do Joelho/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde , Hospitalização , Hospitais , Humanos , Pacientes Internados , Masculino , Medicaid/economia , Alta do Paciente , Resultado do Tratamento , Estados UnidosRESUMO
Although inpatient mortality rates following total hip arthroplasty are low, understanding factors that influence inpatient mortality rates is important. Discharge data from the 2007-2008 HCUP Nationwide Inpatient Sample database were used in this study. Patients were identified based on whether they were admitted for a primary total hip arthroplasty and grouped based on their mortality status. All hip and acetabular fracture patients were excluded. Discharge data revealed 508,150 primary total hip arthroplasties with an inpatient mortality rate of 0.13%. The most significant pre-operative predictors of inpatient mortality were increasing age, weekend admission, increased Charlson co-mobidity score, Medicare payer status, race and a Southern hospital region. The two most significant complications post-operatively leading to increased mortality were pulmonary and cardiovascular complications.
Assuntos
Artroplastia de Quadril/mortalidade , Mortalidade Hospitalar , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/economia , Artroplastia de Quadril/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Masculino , Medicare/economia , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estados Unidos/epidemiologiaRESUMO
PURPOSE: The purpose of this study was to determine the correlation between the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) and Knee Injury Osteoarthritis Outcomes scores (KOOS) and the degree of tibiofemoral cartilage loss on plain radiography and 3T magnetic resonance imaging (MRI). We hypothesize that these subjective outcome scores will have a significant correlation to quantitative joint space loss. METHODS: Data used in the preparation of this article were obtained from the osteoarthritis initiative (OAI) database (OAI public use data sets kMRI_QCart_Eckstein18 and kXR_QJSW_Duryea16). Four hundred and forty-five patients had WOMAC/KOOS scores, quantitative tibiofemoral joints space width on plain radiographs and quantitative tibiofemoral cartilage thickness and per cent full thickness cartilage loss on 3T MRI. Joint space width on plain radiographs was correlated to cartilage thickness on MRI, and WOMAC/KOOS scores were correlated to the degree of cartilage loss using Pearson correlation coefficients. RESULTS: There was a statistically significant correlation between medial and lateral compartment cartilage thickness on MRI and medial and lateral joint space width on plain radiography (r = 0.86, r = 0.80) (p < 0.001). KOOS knee pain score was significantly correlated to increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.34) (p < 0.001). KOOS symptom score was significantly correlated to decreasing joint space width in the medial (r = 0.16) and lateral (r = 0.15) compartment and increasing per cent full thickness cartilage loss in the medial femoral compartment (r = 0.36) (p < 0.001). No WOMAC score was correlated to degree of joint space width, cartilage thickness or per cent full thickness cartilage loss (n.s). CONCLUSION: The WOMAC and KOOS scores are poor indicators of tibiofemoral cartilage loss, with only the KOOS symptom and knee pain score being weakly correlated. Osteoarthritis is a multifactorial process and the need to treat patients based off their symptoms and rely on radiographs as confirmatory modalities, and not diagnostic modalities, when talking about OA and medical intervention.
Assuntos
Cartilagem Articular/patologia , Imageamento por Ressonância Magnética/métodos , Osteoartrite do Joelho/patologia , Índice de Gravidade de Doença , Idoso , Cartilagem Articular/diagnóstico por imagem , Progressão da Doença , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Humanos , Interpretação de Imagem Assistida por Computador , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/patologiaRESUMO
The purpose of this study was to analyze the association between patient demographics and hospital demographics on utilization of total joint arthroplasty in rural and urban populations from the National Inpatient Sample database. Any patient that was discharged after a primary total hip or primary total knee arthroplasty was included in this study. Results showed that rural patients living in a Northeastern hospital region compared to West, less than 65 years of age, females, Blacks and Hispanics were less likely to undergo total joint arthroplasty compared to their urban counterparts. Rural patient were more likely to undergo total joint arthroplasty compared to their urban counterparts if they were in the Midwest and had Medicare as their primary payer provider.
Assuntos
Artroplastia de Substituição/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Estados Unidos , População UrbanaRESUMO
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BACKGROUND: There is concern that rural residents may be less likely to engage in behaviors to reduce their risk for skin cancer compared with urban residents. OBJECTIVES: First, we sought to determine whether rural residents are less likely to use sunscreen and engage in other skin cancer preventive measures. Second, we sought to determine whether such actions are sufficiently explained by factors known to affect these behaviors or whether such actions are affected by rurality. METHODS: We analyzed the 2005 Health Information National Trends Survey, a survey of the noninstitutionalized, adult population performed by the National Cancer Institute. We used logistic regression analysis to adjust for confounding by age, race, income, education, health insurance, smoking, sex, marital status, and region. RESULTS: Compared with urban residents, rural residents were 33% less likely (odds ratio = 0.67; 95% confidence interval, 0.57-0.80) to wear sunscreen when exposed to the sun for more than 1 hour. After adjusting for the above confounding variables, however, rural individuals were just as likely as urban individuals to use sunscreen with sun exposure. LIMITATIONS: Inability to adjust for unmeasured confounding variables, such as occupational sun exposure, is a limitation. CONCLUSION: Rural residents were less likely to use sunscreen. This decreased use of sunscreen, however, was explained by differences in age, race, income, education, and other confounding factors that negatively influence the use of sunscreen.
Assuntos
Comportamentos Relacionados com a Saúde , Neoplasias Induzidas por Radiação/prevenção & controle , População Rural , Neoplasias Cutâneas/prevenção & controle , Luz Solar , População Urbana , Adolescente , Adulto , Idoso , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Roupa de Proteção , Fatores Socioeconômicos , Luz Solar/efeitos adversos , Protetores Solares/administração & dosagem , Estados Unidos , Adulto JovemRESUMO
INTRODUCTION: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an opiate/benzodiazepine combination has been employed. The use of other pharmacologic agents, such as etomidate and propofol, have more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out. The purpose of this study is to compare differences in reduction and sedation outcomes, including recovery times, of these 3 sedation agents. METHODS: We performed a retrospective chart review examining 198 patients who presented with dislocated total hip arthroplasty at 2 academic affiliated medical centers. The patients were grouped according to the type of sedation agent. We calculated percentages of reduction and sedation complications along with recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. We then compared the data for each sedation agent. RESULTS: We found reduction complications rates of 8.7% in the propofol, 24.7% in the etomidate, and 28.9% in the opiate/benzodiazepine groups. The propofol group was significantly different from the other 2agents (p ≤ 0.01). Sedation complications were found 7.3% of the time in the propofol , 11.7% in the etomidate , and 21.3% in the opiate/benzodiazepine group, (p=0.02 propofol vs. others) . Average recovery times were 25.2 minutes for propofol, 30.8 minutes for etomidate, and 44.4 minutes for opiate/benzodiazepine (p = 0.05 for propofol vs. other agents). CONCLUSION: For reduction of dislocated total hip arthroplasty under procedural sedation, propofol appears to have fewer complications and a trend toward more rapid recovery than both etomidate and opiate/benzodiazepine. These data support the use of propofol as first line agent for procedural sedation of dislocated total hip arthroplasty, with fewer complications and a shorter recovery period.
Assuntos
Artroplastia de Quadril/efeitos adversos , Sedação Consciente/métodos , Etomidato/uso terapêutico , Luxação do Quadril/etiologia , Hipnóticos e Sedativos/uso terapêutico , Propofol/uso terapêutico , Idoso , Sedação Consciente/efeitos adversos , Etomidato/efeitos adversos , Feminino , Luxação do Quadril/terapia , Humanos , Hipnóticos e Sedativos/efeitos adversos , Masculino , Propofol/efeitos adversos , Estudos RetrospectivosRESUMO
OBJECTIVE: To determine whether Medicare beneficiaries in rural areas were less likely to undergo a variety of surgical procedures compared with their urban counterparts. DESIGN, SETTING, AND PATIENTS: Cross-sectional study of Medicare beneficiaries. MAIN OUTCOME MEASURE: Any incidence of the surgical procedures studied. RESULTS: Compared with urban Medicare beneficiaries, rural Medicare beneficiaries were more likely to undergo a broad array of surgical procedures: 35% more likely for carotid endarterectomy (odds ratio [OR] = 1.35; 95% confidence interval [CI], 1.33-1.38), 32% for lumbar spine fusion (OR = 1.32; 95% CI, 1.29-1.35), 30% for knee replacement surgery (OR = 1.30; 95% CI, 1.28-1.31), 28% for abdominal aortic aneurysm repair (OR = 1.28; 95% CI, 1.24-1.31), 22% for prostatectomy (OR = 1.22; 95% CI, 1.19-1.24), 19% for hip replacement surgery (OR = 1.19; 95% CI, 1.17-1.21), 18% for aortic valve replacement (OR = 1.18; 95% CI, 1.14-1.21), 16% for open reduction and internal fixation of the femur (OR = 1.16; 95% CI, 1.14-1.18), and 15% for appendectomy (OR = 1.15; 95% CI, 1.11-1.19). To determine whether these differences could be explained by known confounding variables, we then used logistic regression to adjust for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence. Rural beneficiaries were still more likely to undergo all of these surgical procedures. CONCLUSIONS: Medicare beneficiaries living in rural areas were more likely to undergo a broad array of surgical procedures compared with those living in urban areas. While allaying some concern about rural access to surgical procedures, the uniformity of these results raises concern that people living in rural areas may have an overall poorer quality of health.
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Disparidades em Assistência à Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , População Rural/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Fatores de Confusão Epidemiológicos , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estados Unidos , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricosRESUMO
BACKGROUND: Patients with rheumatoid arthritis have an increased risk for accelerated atherosclerosis. It is unknown, however, whether rheumatoid arthritis also increases in-hospital mortality after a myocardial infarction or influences the therapy patients receive. METHODS: A cross-sectional analysis of 1,112,676 patients with myocardial infarction in the 2003-2005 Nationwide Inpatient Sample was performed. RESULTS: Patients with rheumatoid arthritis were 39% more likely to receive medical therapy (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.30-1.49) than interventional therapy. By using logistic regression, we adjusted for confounding variables to determine the effect of rheumatoid arthritis on the selection of therapy and found that rheumatoid arthritis itself was associated with a 38% increased likelihood of undergoing thrombolysis (OR, 1.38; 95% CI, 1.10-1.71) and a 27% increased likelihood of undergoing percutaneous coronary intervention (OR, 1.27; 95% CI, 1.17-1.39). For the primary outcome measure, we determined that patients with rheumatoid arthritis overall had a 24% better in-hospital mortality compared with other patients with a myocardial infarction (OR, 0.76; 95% CI, 0.68-0.86), which was 34% better after adjusting for confounding variables (OR, 0.66; 95% CI, 0.59-0.74). This better in-hospital mortality was seen in patients with rheumatoid arthritis undergoing medical therapy (adjusted OR, 0.67; 95% CI, 0.59-0.75) and percutaneous coronary intervention (adjusted OR, 0.47; 95% CI, 0.32-0.70), but not in patients undergoing thrombolysis or coronary artery bypass grafting. CONCLUSIONS: Among patients with myocardial infarction, rheumatoid arthritis was associated with an increased use of thrombolysis and percutaneous coronary intervention. Moreover, patients with rheumatoid arthritis had an in-hospital survival advantage, particularly those undergoing medical therapy and percutaneous coronary intervention.
Assuntos
Artrite Reumatoide/complicações , Infarto do Miocárdio/complicações , Idoso , Angioplastia Coronária com Balão/estatística & dados numéricos , Intervalos de Confiança , Ponte de Artéria Coronária/estatística & dados numéricos , Estudos Transversais , Feminino , Insuficiência Cardíaca/complicações , Mortalidade Hospitalar , Humanos , Modelos Logísticos , Masculino , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Razão de Chances , Avaliação de Processos e Resultados em Cuidados de Saúde/estatística & dados numéricos , Terapia Trombolítica/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Patients with rheumatoid arthritis have an increased risk for accelerated atherosclerosis. It is not known, however, whether this disorder is associated with a higher risk of complications after coronary artery revascularization. METHODS: We conducted a cross-sectional study of patients in the 2003-2005 Nationwide Inpatient Sample. To determine whether patients with rheumatoid arthritis had higher in-hospital mortality after coronary artery revascularization, we used logistic regression to adjust for age, sex, race/ethnicity, income, rural-urban residency, diabetes, hypertension, hyperlipidemia, Charlson comorbidities (including myocardial infarction, congestive heart failure, and diabetes), elective admission, weekend admission, and primary payer. RESULTS: Among patients undergoing coronary artery revascularization, those with rheumatoid arthritis were 49% less likely to die while hospitalized compared with those without rheumatoid arthritis (odds ratio, 0.51; 95% confidence interval, 0.40-0.65) after adjusting for the above confounders. In subgroup analyses that adjusted for the same confounders, patients with rheumatoid arthritis also had a 61% improvement of in-patient mortality when they underwent percutaneous coronary interventions (odds ratio, 0.39; 95% confidence interval, 0.29-0.54) along with a median of 0.32 less days hospitalized (95% confidence interval, 0.28-0.34 days). Similarly, patients with rheumatoid arthritis undergoing coronary artery bypass grafting had a 31% improvement of in-patient mortality (odds ratio, 0.69; 95% confidence interval, 0.48-0.99), with a median of 1.36 less days hospitalized (95% confidence interval, 0.72-1.12 days). CONCLUSION: Among patients undergoing coronary artery revascularization, patients with rheumatoid arthritis have an in-hospital survival advantage along with reduced days of hospitalization compared with patients without rheumatoid arthritis.
Assuntos
Angioplastia Coronária com Balão/mortalidade , Artrite Reumatoide/mortalidade , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/terapia , Idoso , Angioplastia Coronária com Balão/efeitos adversos , Artrite Reumatoide/complicações , Comorbidade , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Estudos Transversais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: To determine whether health literacy is lower in rural populations. METHOD: We analyzed health, prose, document, and quantitative literacy from the National Assessment of Adult Literacy study. Metropolitan Statistical Area designated participants as rural or urban. RESULTS: Rural populations had lower literacy levels for all literacy types (P<0.001 for each). After adjusting for known confounders, there was no longer a difference in health or prose literacy (P>0.05). However, rural populations had higher document (P=0.04) and quantitative (P=0.01) literacy. CONCLUSION: Health literacy is lower in the rural population although this difference is explained by known confounders.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , População Rural , Estados Unidos , População Urbana , Adulto JovemRESUMO
OBJECTIVE: People in rural areas live farther away from hospitals than do people in urban areas. Thus, there is concern that people living in rural areas may be less willing or able to undergo elective surgical procedures. This study was undertaken to determine whether Medicare beneficiaries in rural areas were less likely to have elective total knee or hip replacement surgeries compared with their urban counterparts. METHODS: We performed a cross-sectional study of Medicare beneficiaries, controlling for age, sex, race/ethnicity, and economic status. Beneficiaries were assigned to rural versus urban areas based on their zip code of residence and the 10-point Rural-Urban Commuting Area designation. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: Compared with urban beneficiaries, rural beneficiaries were 27% more likely to have total knee or hip replacement surgeries (OR 1.27 [95% CI 1.26-1.28]). After adjusting for age, sex, race/ethnicity, median household income, average house value, mean poverty ratio, and state of residence, rural beneficiaries were still 14% more likely to have total joint replacement surgeries (OR 1.14 [95% CI 1.13-1.16]). Differential use of surgery before and after receiving Medicare eligibility did not explain the findings. While significant sex, racial, and ethnic disparities were present in both rural and urban areas, for the most part these disparities were ameliorated rather than accentuated in rural areas. CONCLUSION: Contrary to expectations, our findings indicate that Medicare beneficiaries living in rural areas are more likely to undergo total knee or hip replacement surgeries.