Abstract
Our objective was to assess healthcare utilization and complication rates after primary total knee/hip arthroplasty (TKA/THA) in people with spondyloarthritis (SpA) compared with people without SpA. We performed multivariable-adjusted logistic regression using the 1998–2014 US National Inpatient Sample (NIS), adjusted for age, race/ethnicity, gender, income, Deyo-Charlson comorbidity index, insurance payer, and the underlying diagnosis. The primary THA cohort consisted of 4,116,484 THAs (1.7% with SpA) and primary TKA cohort of 8,127,282 TKAs (1% with SpA). Compared with people without SpA, people with SpA had higher odds ratio (OR (95% confidence interval (CI)) of the following post-THA and post-TKA, respectively: (1) discharge to care facility, 1.16 (1.12, 1.21) and 1.14 (1.11, 1.18); (2) hospital stay > 3 days, 1.15 (1.11, 1.20) and 1.05 (1.01, 1.10); and (3) transfusion, 1.16 (1.12, 1.21) and 1.10 (1.05, 1.14); but lower odds of (1) mortality, 0.78 (0.64, 0.96) and 0.40 (0.19, 0.84); and (2) hospital charges above the median, 0.49 (0.46, 0.53) and 0.48 (0.45, 0.51). SpA was associated with higher odds of implant infection, 3.02 (2.27, 4.03) post-TKA, not post-THA. In-hospital revision rate did not differ. People with SpA utilize more healthcare services and have more complications post-THA/TKA. Interventions to reduce complications and associated utilization are needed.
Key Points • People with spondyloarthritis utilized more healthcare services and had a higher risk of transfusion post-THA/TKA, compared with people without spondyloarthritis. • Spondyloarthritis was associated with lower in-hospital mortality rates after THA/TKA. • Spondyloarthritis was associated with a higher risk of implant infection after TKA, but not THA. • A pre-operative discussion with people with spondyloarthritis of possibly higher implant infection after TKA could lead to a more informed consent. |
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This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, Alabama, USA.
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Mr. Cleveland had full access to all of the data in the study and takes the responsibility for the integrity of the data and accuracy of the data analysis. He was supervised by Dr. Singh, who reviewed all results. Study Concept and Design: Singh. Data acquisition, analysis, and interpretation of results: Singh, Cleveland. Drafting of the manuscript: Singh. Critical revision of the manuscript for important intellectual content: Singh, Cleveland. Statistical analysis: Cleveland. Obtained funding: Singh. Administrative, technical, or material support: Singh. Study supervision: Singh.
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There are no financial conflicts related directly to this study. JAS has received consultant fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Medscape, WebMD, Clinical Care options, Clearview Healthcare Partners, Putnam Associates, Spherix, and the National Institutes of Health and the American College of Rheumatology. JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS is on the speaker’s bureau of Simply Speaking. JAS is a member of the executive of OMERACT, an organization that develops outcome measures in rheumatology and receives arms-length funding from 36 companies. JAS serves on the FDA Arthritis Advisory Committee. JAS is a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JAS previously served as a member of the following committees: member, the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC) and Quality of Care Committees, the Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee and the co-chair of the ACR Criteria and Response Criteria subcommittee. JDC has no conflicts.
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The University of Alabama at Birmingham’s Institutional Review Board approved this study and waived the need for informed consent for this database study (X120207004). All investigations were conducted in conformity with ethical principles of research.
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Singh, J.A., Cleveland, J.D. Spondyloarthritis is associated with higher healthcare utilization and complication rates after primary total knee or total hip arthroplasty. Clin Rheumatol 39, 2345–2353 (2020). https://doi.org/10.1007/s10067-020-05036-0
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DOI: https://doi.org/10.1007/s10067-020-05036-0