Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Knee Arthroplasty.

BACKGROUND: Frailty can predict adverse outcomes after various orthopaedic procedures, but is not well-studied in revision total knee arthroplasty (rTKA). We investigated the correlation between the Hospital Frailty Risk Score (HFRS) and post-rTKA outcomes. METHODS: Using the Nationwide Readmissions Database, we identified rTKA patients discharged from January 2017 to November 2019 for the most common diagnoses (mechanical loosening, infection, and instability). Using HFRS, we compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients with multivariate and binomial regressions. The 30-day complication and reoperation rates were compared using univariate analyses. We identified 25,177 mechanical loosening patients, 12,712 infection patients, and 9,458 instability patients. RESULTS: Frail patients had higher rates of 30-day readmission (7.8 versus 3.7% for loosening, 13.5 versus 8.1% for infection, 8.7 versus 3.9% for instability; P < .01), longer length of stay (4.1 versus 2.4 days for loosening, 8.1 versus 4.4 days for infection, 4.9 versus 2.4 days for instability; P < .01), and greater cost ($32,082 versus $27,582 for loosening, $32,898 versus $28,115 for infection, $29,790 versus $24,164 for instability; P < .01). Frail loosening patients had higher 30-day complication (6.8 versus 2.9%, P < .01) and reoperation rates (1.8 versus 1.2%, P = .01). Frail infection patients had higher 30-day complication rates (14.0 versus 8.3%, P < .01). Frail instability patients had higher 30-day complication (8.0 versus 3.5%, P < .01) and reoperation rates (3.2 versus 1.6%, P < .01). CONCLUSIONS: The HFRS may identify patients at risk for adverse events and increased costs after rTKA. Further research is needed to determine causation and mitigate complications and costs.

Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Total Hip Arthroplasty.

BACKGROUND: Frailty has been associated with poor outcomes and higher costs after primary total hip arthroplasty. However, frailty has not been studied in relation to outcomes after revision total hip arthroplasty (rTHA). This study examined the relationship between the Hospital Frailty Risk Score (HFRS), postoperative outcomes, and cost profiles following rTHA. METHODS: In this retrospective cohort study, we identified patients who underwent rTHA from January 2017 to November 2019 in the Nationwide Readmission Database. The 3 most frequently reported diagnosis codes for rTHA were then selected: dislocation; mechanical loosening; and infection. We calculated the HFRS for each patient to determine frailty status. We compared 30-day readmission rate, length of stay, and hospitalization cost between frail and nonfrail patients, using multivariate logistic and negative binomial regressions to adjust for covariates. We identified 36,243 total patients who underwent rTHA. Overall, 15,448 patients had a revision for dislocation, 11,062 for mechanical loosening, and 9,733 for infection. RESULTS: Compared to nonfrail patients, frail patients had higher rates of 30-day readmission, longer length of stay, and higher hospitalization cost. Frail patients had significantly higher rates of 30-day complication and 30-day reoperation. CONCLUSIONS: Frailty, measured using HFRS, is associated with increased postoperative complications and costs after rTHA. The HFRS has the ability to efficiently identify frail patients at-risk for perioperative complications enabling care teams to better focus optimization interventions on this patient cohort.

Frailty is Associated With Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Knee Arthroplasty.

BACKGROUND: Frailty has been associated with poor postoperative outcomes in various medical conditions and surgical procedures. However, the relationship between frailty and outcomes after primary total knee arthroplasty (TKA) has not been well-described. This study investigated the association of the Hospital Frailty Risk Score (HFRS) with postoperative events and hospitalization costs after primary TKA. METHODS: Using a nationwide readmissions database, we identified 884,479 patients discharged after primary TKA for osteoarthritis between January 2017 and November 2019. HFRS was calculated for each patient to determine frailty status. We used multivariate logistic regressions to evaluate the association of frailty with 30-readmission rate and negative binomial regressions to evaluate lengths of hospital stay and hospitalization costs. The 30-day reoperation and complication rates were compared using chi-square tests. RESULTS: Frailty was associated with increased odds of 30-day readmissions (odds ratio [OR]: 1.89, 95% confidence interval [CI]: 1.82-1.96), longer lengths of stay (OR: 1.43, 95% CI: 1.43-1.44), and higher hospitalization costs (OR: 1.16, 95% CI: 1.16-1.17). Frail patients also had significantly higher rates of 30-day reoperations (0.6 versus 0.4%), surgical complications (0.6 versus 0.4%), medical complications (3.4 versus 1.3%), and other complications (0.9 versus 0.5%) (P < .01). CONCLUSIONS: Frailty, as measured using HFRS, was associated with increased adverse events and health care burdens in patients undergoing TKA. The HFRS could be used to swiftly identify high-risk patients undergoing TKA and to potentially help optimize patients prior to elective TKA. TYPE OF STUDY: Level III retrospective cohort study.

Frailty Is Associated With Increased 30-Day Adverse Events and Hospitalization Costs After Primary Total Hip Arthroplasty.

BACKGROUND: Frailty can predict adverse outcomes for multiple medical conditions and surgeries but is not well studied in total hip arthroplasty (THA). We evaluate the association between Hospital Frailty Risk Score and postoperative events and costs after primary THA. METHODS: Using the National Readmissions Database, we identified primary THA patients for osteoarthritis, osteonecrosis, or hip fracture from January to November 2017. Using Hospital Frailty Risk Score, we compared 30-day readmission rate, hospital course duration, and costs between frail and nonfrail patients for each diagnosis, controlling for covariates. Thirty-day complication and reoperation rates were compared using univariate analysis. RESULTS: We identified 167,700 THAs for osteoarthritis, 5353 for osteonecrosis, and 7246 for hip fractures. Frail patients had increased 30-day readmission rates (5.3% vs 2.5% for osteoarthritis, 7.1% vs 3.3% for osteonecrosis, 8.4% vs 4.3% for fracture; P < .01), longer hospital course (3.4 vs 1.9 days for osteoarthritis, 4.1 vs 2.1 days for osteonecrosis, 6.3 vs 3.9 days for fracture; P < .01), and increased costs ($18,712 vs $16,142 for osteoarthritis, $19,876 vs $16,060 for osteonecrosis, $22,185 vs $19,613 for fracture; P < .01). Frail osteoarthritis patients had higher 30-day complication (4.4% vs 1.9%; P < .01) and reoperation rates (1.6% vs 0.93%; P < .01). Frail osteonecrosis patients had higher 30-day complication rates (5.3% vs 2.6%; P < .01). Frail hip fracture patients had higher 30-day complication (6.6% vs 3.8%; P < .01) and reoperation rates (2.9% vs 1.8%; P < .01). CONCLUSION: Frailty is associated with increased healthcare burden and postoperative events after primary THA. Further research can identify high-risk patients and mitigate complications and costs.

Economic Recovery After the COVID-19 Pandemic: Resuming Elective Orthopedic Surgery and Total Joint Arthroplasty.

BACKGROUND: The economic effects of the COVID-19 crisis are not like anything the U.S. health care system has ever experienced. METHODS: As we begin to emerge from the peak of the COVID-19 pandemic, we need to plan the sustainable resumption of elective procedures. We must first ensure the safety of our patients and surgical staff. It must be a priority to monitor the availability of supplies for the continued care of patients suffering from COVID-19. As we resume elective orthopedic surgery and total joint arthroplasty, we must begin to reduce expenses by renegotiating vendor contracts, use ambulatory surgery centers and hospital outpatient departments in a safe and effective manner, adhere to strict evidence-based and COVID-19-adjusted practices, and incorporate telemedicine and other technology platforms when feasible for health care systems and orthopedic groups to survive economically. RESULTS: The return to normalcy will be slow and may be different than what we are accustomed to, but we must work together to plan a transition to a more sustainable health care reality which accommodates a COVID-19 world. CONCLUSION: Our goal should be using these lessons to achieve a healthy and successful 2021 fiscal year.

Risk factors associated with persistent chronic opioid use following THA.

INTRODUCTION: An understanding of patient characteristics associated with persistent chronic opioid use after total joint arthroplasty (TJA) will allow surgeons to better manage these patients. Our study aims to identify risk factors among preoperative chronic opioid users who continue to chronically use narcotics after total hip arthroplasty (THA). METHODS: A retrospective analysis was performed on 256 THA recipients using the state's mandated opioid monitoring program to identify preoperative chronic opioid users. Chronic users were stratified into two cohorts based on their use 6 months after surgery: (1) persistent chronic and (2) previous chronic users. Patient demographics and relevant histories were abstracted and comparatively assessed between the cohorts. In addition, an analysis was performed to calculate which preoperative opioid dose was most predictive of chronic use. RESULTS: Within the study population, 54 patients were identified as preoperative chronic opioid users. Of them, 13 (24.1%) were identified as persistent chronic users 6 months following surgery. Specific characteristics associated with a higher likelihood of persistent chronic opioid use included: male gender, ASA score > 2, and Medicare as a payer type. A 33 mg/day morphine-equivalent dose consumption prior to surgery was most predictive for persistent chronic opioid use. CONCLUSION: Our study demonstrates that patients who are male, have an ASA > 2, and use Medicare are at greater risk of persistent chronic opioid use. Thus, given the poor outcomes associated with chronic opioid use, these findings may help guide surgeons' clinical decision-making process when encountering patients with a history of opioid use.

Correlation of Single Assessment Numeric Evaluation (SANE) with other Patient Reported Outcome Measures (PROMs).

BACKGROUND: The Single Assessment Numeric Evaluation (SANE) is a simple, one-question patient-reported outcome measure (PROM). We systematically reviewed correlations between SANE and more extensive PROMs. METHODS: We identified studies with correlation coefficients between SANE and other shoulder, knee, and ankle-specific PROMs. We calculated mean, median and range across studies and time points of data collection. RESULTS: Eleven studies provided 14 correlations, six shoulder-specific PROMs in four studies, six knee-specific PROMs in six studies and two ankle specific PROMs in one study. The mean correlation comparing SANE and knee-specific PROMs was 0.60 (SD 0.24), median 0.66, and range 0.12 to 0.88. Among studies comparing SANE and shoulder-specific PROMs mean correlation was 0.59 (SD 0.20), median 0.62 and range 0.20 to 0.89. The mean correlation between SANE and ankle-specific PROMs was 0.69 (SD 0.17), median 0.69 and range 0.75 to 0.81. CONCLUSION: There seems to be moderate correlation amongst PROMs, even those that are a single question. Future research might address whether patient reported outcome measure a common underlying construct even when they consist of a single question.