RESUMO
BACKGROUND: In the past decade the prevalence of end stage inflammatory elbow arthritis has declined with consequential changes in indications and utilization of total elbow arthroplasty (TEA). Current literature lacks future projections for the utilization of TEA. This aim of this study is to review the trends in utilization of TEA in last two decades and determine the projections of utilization for TEA (primary and revision) through 2060. METHODS: This analysis utilized the publicly available 2000-2019 data from the CMS Medicare Part-B National Summary. Procedure volumes including TEA, and revision TEA, were determined using current procedural terminology (CPT) codes and were uplifted to account for the growing number of Medicare eligible patients covered under Medicare Advantage. Using these volumes log-linear, Poisson, negative binomial regression, and autoregressive integrated moving average (ARIMA) models were applied to generate projections from 2020-2060. The Poisson model was chosen to display the data based on error analysis and prior literature. RESULTS: The projected annual growth rate from 2020 to 2060 for primary and revision TEA are 1.03% growth (95% CI 0.82% - 1.25%) and 5.17% growth (95% CI 3.02%-6.97%), respectively. By 2060, the demand for primary TEA and revision TEA is projected to be 2084 procedures (95% FI 1995 - 2174) and 3161 procedure (95% FI 3052 - 3272), respectively. The procedure volume for revision TEA is estimated to outnumber primary TEA by year 2050. CONCLUSION: The overall procedural volume of primary TEA, and revision TEA continues to be low. Although it is estimated that the incidence of primary and revision TEA will continue to increase in next 40 years, the utilization trends only show mild increase, which is five times higher for revision TEA compared to primary TEA.
RESUMO
BACKGROUND: Since 2021, the Centers for Medicare and Medicaid Services have mandated that patients have open access to their medical records. Many institutions use online portals, which allow patients to access their health information and communicate with care teams. Our research aimed to evaluate demographic patterns for online patient portal utilization in patients undergoing total knee arthroplasty (TKA). Further, we assessed if and how portal engagement contributes to perioperative outcomes. METHODS: This study retrospectively reviewed primary and elective TKA from 2017 to 2022 at a single academic institution. Patients were stratified into 2 groups based on their online portal status: activated (A) or not-activated (NA). Baseline characteristics and postoperative outcomes were collected from the electronic medical record and compared. RESULTS: In total, 10,995 patients were included: 8,330 (75.8%) were A and 2,625 (24.2%) were NA. The NA group was significantly older (P < .001); more likely to be Black (P < .001), women (P < .001), single/divorced/widowed (P < .001), non-English speaking (P < .001), and Medicare or Medicaid insured (P < .001); from zip codes with median incomes below $50,000 (P < .001), and more likely to be American Society of Anesthesiologists class III or IV (P < .001). Patient-reported outcome measure completion rates were significantly lower in the NA group (15.3 versus 47.7%, P < .001). Lengths of stay (LOS) were significantly higher in the NA group (2.7 versus 2.1 days, P < .001). The NA group was significantly more likely to be discharged to skilled nursing facilities (P < .001). Comparable rates of 90-day emergency department visits, readmissions, as well as 90-day and 2-year revisions, were observed across groups. CONCLUSIONS: There are significant disparities in online portal activation status based on patient demographics. Patients who have A portals had significantly higher Patient-reported outcome measure completion rates, shorter LOS, and higher rates of home discharge. Further research should determine which other factors may affect patient portal utilization and inform interventions to improve portal utilization among minority populations.