Outcomes following robotic assisted total knee arthroplasty compared to conventional total knee arthroplasty.

INTRODUCTION: This study elaborates on previous research to compare length of stay, complication rates, and total cost between patients undergoing robotic assisted total knee arthroplasty (rTKA) and conventional total knee arthroplasty (cTKA). We hypothesized that patients undergoing rTKA would have reduced length of stay, lower complication rates, improved perioperative outcomes, and higher total healthcare costs than those undergoing cTKA. METHODS: Data were collected from the National Inpatient Sample Database Healthcare Cost and Utilization Project between the years 2016-2019. Patients undergoing rTKA and cTKA were identified under International Classification of Diseases, 10th revision codes (ICD-10-CM/PCS). Length of stay, specific complications, and total costs were examined at time point. SPSS (v 27.0 8, IBM Corp. Armonk, NY) was utilized to compare demographic and analytical statistics between rTKA and cTKA. rTKA and cTKA were compared both before and after propensity matching. RESULTS: 17,249 rTKA (3.09%) and 541,122 cTKA (96.91%) were included. Compared to cTKA patients, rTKA patients had reduced average length of stay of 1.91 days (p < 0.001), higher average total cost of $67133.34 (p < 0.001), reduced periprosthetic infection (OR = 0.027, p < 0.001), periprosthetic dislocation (OR = 0.117, p < 0.001), periprosthetic mechanical complication (OR = 0.315, p < 0.001), pulmonary embolism (OR = 0.358, p < 0.001), transfusion (OR = 0.366, p < 0.001), pneumonia (OR = 0.468, p = 0.002), deep vein thrombosis (OR = 0.479, p = 0.001), and blood loss anemia (OR = 0.728, p < 0.001). These differences remained statistically significant even after propensity matching. CONCLUSIONS: This study supports our hypothesis that rTKA is associated with fewer complications, but higher average total cost than cTKA. Our study shows that rTKA can be safely performed in older and sicker patients. Future studies assessing the impacts of these findings on patient reported outcomes would provide further insight into the benefits of rTKA. Furthermore, identifying patient specific factors that place them at risk for increased complications with cTKA as opposed to rTKA could provide surgeons insight on the method of TKA that maximizes patient outcomes while minimizing healthcare cost.

Racial variations in complications and costs following total knee arthroplasty: a retrospective matched cohort study.

INTRODUCTION: In this study, we evaluate how race corresponds to specific complications and costs following total knee arthroplasty (TKA). Our hypothesis was that minority patients, comprising Black, Asian, and Hispanic patients, would have higher complication and revision rates and costs than White patients. METHODS: Data from 2014 to 2016 were collected from a large commercial insurance database. TKA patients were assigned under Current Procedural Terminology (CPT-27447) and International Statistical Classification of Diseases (ICD-9-P-8154) codes. Minority patients were compared to White patients before and after matching for age, gender, and tobacco use, diabetes, and obesity comorbidities. Standardized complications, revisions, and total costs at 30 days, 90 days, and 1 year were compared between the groups using unequal variance t tests. RESULTS: Overall, 140,601 White (92%), 10,247 Black (6.7%), 1072 Asian (0.67%), and 1725 Hispanic (1.1%) TKA patients were included. At baseline, minority patients had 7-10% longer lengths of stay (p = 0.0001) and Black and Hispanic patients had higher Charlson and Elixhauser comorbidity indices (p = 0.0001), while Asian patients had a lower Elixhauser comorbidity index (p < 0.0001). Black patients had significantly higher complication rates and higher rates of revision (p = 0.03). Minority patients were charged 10-32% more (p < 0.0001). Following matching, all minority patients had lengths of stay 8-10% longer (p = 0.001) and Black patients had higher Charlson and Elixhauser comorbidity indices (p < 0.0001) while Asian patients had a lower Elixhauser comorbidity index (p = 0.0008). Black patients had more equal complication rates and there was no significant difference in revisions in any minority cohort. All minority cohorts had significantly higher total costs at all time points, ranging from 9 to 31% (p < 0.0001). CONCLUSION: Compared to White patients, Black patients had significantly increased rates of complications, along with greater total costs, but not revisions. Asian and Hispanic patients, however, did not have significant differences in complications or revisions yet still had higher costs. As a result, this study corroborates our hypothesis that Black patients have higher rates of complications and costs than White patients following total knee arthroplasty and recommends efforts be taken to tackle health inequities to create more fairness in healthcare. This same hypothesis, however, was not supported when evaluating Asian and Hispanic patients, probably because of the few patients included in the database and deserves further investigation.

What enhances the in-hospital mortality following total hip arthroplasty? A national inpatient sample-based study.

PURPOSE: With prolonged life expectancy and advancements in prosthetic designs, the proportion of patients belonging to diverse age groups undergoing total hip arthroplasty (THA) has progressively increased. In this context, the details regarding risk factors associated with mortality after THA, and its prevalence need to be clearly understood. This study sought to identify the possible co-morbidities associated with post-THA mortality. METHODS: Based on Nationwide Inpatient Sample (NIS) database, patients undergoing THA from 2016 to 2019 (using ICD-10CMP) were identified. The included cohort was stratified into two groups: "early mortality" and "no mortality" groups. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS: Overall, 337,249 patients underwent THA, among whom, 332 (0.1%) died during their hospital admission ("early mortality" group). The remaining patients were included under "no mortality" group (336,917 patients). There was significantly higher mortality in the patients, who underwent emergent THA (as compared with elective THA: odd's ratio 0.075; p < 0.001). Based on multivariate analysis, presence of liver cirrhosis, chronic kidney disease (CKD) and previous history of organ transplant increased the odds of mortality {odds ratio [Exp (B)]} after THA by 4.66- (p < 0.001), 2.37-fold (p < 0.001) and 1.91-fold (p = 0.04), respectively. Among post-THA complications, acute renal failure (ARF), pulmonary embolism (PE), pneumonia, myocardial infarction (MI), and prosthetic dislocation increased the odds of post-THA mortality by 20.64-fold (p < 0.001), 19.35-fold (p < 0.001), 8.21-fold (p < 0.001), 2.71-fold (p = 0.05) and 2.54-fold (p < 0.001), respectively. CONCLUSION: THA is a safe surgery with low mortality rate during early post-operative period. Cirrhosis, CKD, and previous history of organ transplant were the most common co-morbidities associated with post-THA mortality. Among post-operative complications, ARF, PE, pneumonia, MI, and prosthetic dislocation substantially enhanced the odds of post-THA mortality.

Complications and Costs Associated With Ethnicity Following Total Hip Arthroplasty: A Retrospective Matched Cohort Study.

BACKGROUND: Minority patients often have greater numbers of complications, revisions, and costs after total hip arthroplasty (THA). This study investigates how race correlates with specific surgical complications, revisions, and total costs following THA both before and after propensity matching. METHODS: Data from 2014-2016 were collected from a large commercial insurance database known as PearlDiver. THA patients were assigned under Current Procedural Terminology (CPT-27130) and International Statistical Classification of Diseases (ICD-9-P-8151) codes and then divided into groups based on racial status in the database. Patients of different ethnicities including White, Black, Asian, and Hispanic patients were compared in regard to age, gender, comorbidities, lengths of stay, and surgical complications and costs at thirty days, ninety days, and one year using unequal variance t-tests. Black, Asian, and Hispanic patients are collectively referred to as minority patients. Patient comparisons were done both before and after matching for age, gender, tobacco use, diabetes, and obesity comorbidities. RESULTS: A total of 73,688 White (93%), 4,822 Black (6%), 268 Asian (0.3%), and 420 Hispanic (0.5%) THA patients were included. Significantly more minority patients underwent THA under the age of 65 and had higher comorbidity indices and lengths of stay. Black patients had significantly higher complication rates, but there was no significant difference in rates of revision in any minority group. Minority patients were charged 9%-83% more. After matching, Black and Hispanic patients maintained higher comorbidity indices and lengths of stay. Black patients had a spectrum of complication rates but significantly decreased revision rates. Furthermore, after matching, minority patients were charged 5%-65% more. CONCLUSIONS: Black patients experienced significantly greater rates of complications and higher total costs; whereas, Asian and Hispanic patients did not have significant differences in complications but did have higher costs. Therefore, this study aligns with previous studies and supports our hypothesis that Black ethnicity patients have worse outcomes than White ethnicity patients after THA, advocating for reducing health disparities and establishing more equitable healthcare, but does not support our hypothesis for Asian and Hispanic patients, likely due to a small study population size, warranting further research into the topic.

The Impact of Obesity on Total Hip Arthroplasty Outcomes: A Retrospective Matched Cohort Study.

Aim Previous research has shown that obesity is associated with worse postoperative outcomes. We aim to determine how rates of specific complications after total hip arthroplasty (THA) align with obesity status. We hypothesize that obese patients would have higher rates of complications and cost and thus have worse outcomes than non-obese patients. Methods Data were collected from a large commercial insurance database between 2011 and 2020. Patients underwent a hip replacement under current procedural terminology (CPT) and International Statistical Classification of Diseases (ICD-9/ICD-10) codes. Obese (defined as having a BMI of 30 kg/m2 or higher) and non-obese patients were matched on age, gender, Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI). Standardized complications and costs in one year were compared using unequal variance t-tests. Results Under CPT codes, 61,462 obese (45% male) and 61,462 non-obese patients (45% male) underwent a hip replacement. Obese patients had significantly higher rates of surgical site infection (SSI) (OR=1.193, p=0.0001), deep vein thrombosis (DVT) (OR=1.275, p=0.001), wound complication (OR=1.736, p<0.0001), hematoma (OR=1.242, p=0.0001), pulmonary embolism (OR=1.141, p=0.0355), UTI (OR=1.065, p=0.0016), and opioid prescriptions (OR=1.17, p<0.0001), and significantly lower rates of arrhythmia (OR=0.907, p<0.0001), congestive heart failure (CHF) (OR=0.863, p<0.0001), cardiac arrest (OR=0.637 p<0.0001), pneumonia (OR=0.795, p<0.0001), and transfusion (OR=0.777, p<0.0001). Furthermore, obese patients were significantly more likely to undergo revision within 10 years (OR=1.172, p<0.0001). Under ICD codes, 31,922 obese (45% male) and 31,922 non-obese patients (45% male) were included. Obese patients did not have a significant difference in total cost or drug cost. Conclusions Obese patients had significantly higher rates of infection, venous thromboembolic event, wound complication, hematoma, and opioid prescriptions but significantly lower rates of cardiac issues, pneumonia, and transfusion, after hip replacement. Additionally, there was no significant difference in total or drug cost. Therefore, this study did not support our hypothesis that obese patients have worse outcomes than non-obese patients, as there neither was a clear significant increase in complication rates nor a significant increase in costs. However, further research should be done to better understand the complex relationship between obesity and postoperative outcomes.

The impact of obesity on total knee arthroplasty outcomes: A retrospective matched cohort study.

Background: Total Knee Arthroplasty (TKA) is a common orthopaedic surgery to treat advanced knee arthritis. Post-operative complications can be affected by obesity, defined as a body mass index of 30 kg/m2 or higher. We examine the rates of specific complications, revision rates, and costs of care following TKA and compare them between multifactor matched obese and non-obese patients. We hypothesize these outcomes will be worse in obese patients than in non-obese patients. Methods: This retrospective study of the PearlDiver database queries for patients who underwent TKA under Current Procedural Terminology (CPT) and International Statistical Classification of Diseases (ICD-9) codes between January 2011 and January 2020. Patients were matched based on age, gender, and comorbidity indices, and various complications, revision rates, and costs were compared between the matched obese and non-obese patient groups. Results: Obesity was associated with higher rates of surgical complications, such as wound complications, surgical site infections, need for revision, and higher total cost of care one year after TKA, and medical complications such as, acute kidney injury, deep vein thrombosis, urinary tract infection, and narcotics use, but significantly lower rates of anemia, arrhythmia, cardiac arrest, pneumonia, and transfusion. Obese patients also experienced significantly lower drug costs of care. Conclusion: Outcomes were not definitively worse in obese patients when compared to matched non-obese patients. Nevertheless, understanding the complications that can arise following TKA will assist in educating patients about potential risks from surgery and guide surgeons in caring for their patients as obesity is predicted to continue increasing in prevalence. As such, future studies should examine underlying mechanisms that cause these complications to develop potential therapies.

Systematic Analysis of Actively Transcribed Core Matrisome Genes Across Tissues and Cell Phenotypes.

The extracellular matrix (ECM) is a highly dynamic, well-organized acellular network of tissue-specific biomolecules, that can be divided into structural or core ECM proteins and ECM-associated proteins. The ECM serves as a blueprint for organ development and function and, when structurally altered through mutation, altered expression, or degradation, can lead to debilitating syndromes that often affect one tissue more than another. Cross-referencing the FANTOM5 SSTAR (Semantic catalog of Samples, Transcription initiation And Regulators) and the defined catalog of core matrisome ECM (glyco)proteins, we conducted a comprehensive analysis of 511 different human samples to annotate the context-specific transcription of the individual components of the defined matrisome. Relative log expression normalized SSTAR cap analysis gene expression peak data files were downloaded from the FANTOM5 online database and filtered to exclude all cell lines and diseased tissues. Promoter-level expression values were categorized further into eight core tissue systems and three major ECM categories: proteoglycans, glycoproteins, and collagens. Hierarchical clustering and correlation analyses were conducted to identify complex relationships in promoter-driven gene expression activity. Integration of the core matrisome and curated FANTOM5 SSTAR data creates a unique tool that provides insight into the promoter-level expression of ECM-encoding genes in a tissue- and cell-specific manner. Unbiased clustering of cap analysis gene expression peak data reveals unique ECM signatures within defined tissue systems. Correlation analysis among tissue systems exposes both positive and negative correlation of ECM promoters with varying levels of significance. This tool can be used to provide new insight into the relationships between ECM components and tissues and can inform future research on the ECM in human disease and development. We invite the matrix biology community to continue to explore and discuss this dataset as part of a larger and continuing conversation about the human ECM. An interactive web tool can be found at matrixpromoterome.github.io along with additional resources that can be found at dx.doi.org/10.6084/m9.figshare.19794481 (figures) and https://figshare.com/s/e18ecbc3ae5aaf919b78 (python notebook).

Differences Between Total Ankle Replacement and Ankle Arthrodesis in Post-operative Complications and Reoperations at 30 Days and One Year.

Purpose Total ankle replacement (TAR) and ankle arthrodesis (AA) are two commonly performed procedures for end-stage arthritis of the ankle joint. The aim of this study was to analyze the differences in the rates of complications and reoperations at both 30 days and one year within a matched sample of TAR and AA patients from a large database population. Methods A commercially available patient database record, known as the PearlDiver database (www.pearldiverinc.com, Colorado Springs, CO, USA), was used for this study. Patients undergoing TAR and AA were identified using Current Procedural Terminology (CPT) codes. After matching both TAR and AA groups for confounding variables, such as diabetes, smoking, obesity, and comorbidities scores, the differences in the rates of complications at 30 days and one year and the rate of reoperation at one year were evaluated in both groups. Results After matching for confounding variables, there were 1287 patients in each group. There was no significant difference in the male/female ratio. Within each group, 430 patients were diabetic, 102 patients smoked, and 543 patients were obese. The rate of surgical site infection (SSI) and wound dehiscence were higher at 30 days in the AA group. About 63.45% of complications happened after 30 days. The AA group showed a higher rate of SSI, wound dehiscence, mechanical complications, and pneumonia at one year. The rate of reoperation was also higher in the AA group at one year. Conclusion Ankle arthrodesis is associated with a higher rate of local and systemic complications at 30 days and one year, along with a higher reoperation rate at one year, when compared to total ankle replacement. Most complications happened after 30 days, suggesting that studies reporting complications within 30 days following AA and TAR may underestimate the true rates of complications.