Discriminative Ability of Elixhauser's Comorbidity Measure is Superior to Other Comorbidity Scores for Inpatient Adverse Outcomes After Total Hip Arthroplasty

2018 ◽  
Vol 33 (1) ◽  
pp. 250-257 ◽  
Author(s):  
Nathaniel T. Ondeck ◽  
Daniel D. Bohl ◽  
Patawut Bovonratwet ◽  
Ryan P. McLynn ◽  
Jonathan J. Cui ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Outcomes ◽  
Discriminative Ability ◽  
Total Hip ◽  
Comorbidity Scores ◽  
Comorbidity Measure

scholarly journals Diabetes Status Affects Odds of Body Mass Index–dependent Adverse Outcomes After Total Hip Arthroplasty

2021 ◽  
Vol 29 (2) ◽  
pp. 71-77
Author(s):  
Kareem J. Kebaish ◽  
Varun Puvanesarajah ◽  
Sandesh Rao ◽  
Bo Zhang ◽  
Taylor D. Ottesen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Hip Arthroplasty ◽  
Body Mass ◽  
Hip Arthroplasty ◽  
Adverse Outcomes ◽  
Total Hip ◽  
Diabetes Status

Hip arthroscopy for hip osteoarthritis is associated with increased risk for revision after total hip arthroplasty

2020 ◽  
pp. 112070002091104 ◽  
Author(s):  
Michael-Alexander Malahias ◽  
Alex Gu ◽  
Shawn S Richardson ◽  
Ivan De Martino ◽  
Peter K Sculco ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Hip Arthroscopy ◽  
Conversion Rate ◽  
Hip Osteoarthritis ◽  
Adverse Outcomes ◽  
Total Hip ◽  
Conversion Rates ◽  
Increased Risk ◽  
Insurance Database

Background: It has not been determined yet whether hip arthroscopy (HA) leads to adverse outcomes after total hip arthroplasty (THA). The purpose of this study was to (1) determine 2-year conversion rate of HA done for osteoarthritis (OA) to THA and (2) explore the relationship between HA performed in patients with hip osteoarthritis and the risk of revision THA within 2 years of index arthroplasty. Methods: Data was collected from the Medicare Standardized Analytic Files insurance database using the PearlDiver Patient Records Database from 2005–2016. Patients were stratified into 2 groups based upon a history of hip arthroscopy prior to THA. Results: The 2-year conversion to THA rate for hip arthroscopy in patients with OA was 68.4% (95% CI, 66.2–70.6%). Multivariate analysis demonstrated that OA patients who underwent HA prior to THA were at an increased risk of revision surgery (OR 3.72; 95% CI, 3.15–4.57; p  = 0.012), periprosthetic joint infection (OR 1.86; 95% CI, 1.26–2.77, p  = 0.010) and aseptic loosening (OR 2.81; 95% CI, 1.66–4.76; p  < 0.001) within 2 years of THA. Conclusions: Analysis of a large insurance database found the conversion rate from HA performed in Medicare OA patients to THA within 2 years is unacceptably high. Hip arthroscopy prior to THA also significantly increased the risk of THA revision within 2 years after index THA. These results suggest that arthroscopic hip surgery should not be performed in patients with a diagnosis of OA as conversion rates are high and revision rates post THA are significantly increased.

Patients with insulin-dependent diabetes are at greater risk for perioperative adverse outcomes following total hip arthroplasty

2021 ◽  
pp. 112070002098883
Author(s):  
Matthew L Webb ◽  
Marissa A Justen ◽  
Yehuda E Kerbel ◽  
Christopher M Scanlon ◽  
Charles L Nelson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Outcomes ◽  
Improvement Program ◽  
Total Hip ◽  
Increased Risk ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic ◽  
Insulin Use

Background: The prevalence of diabetes mellitus (DM) continues to increase among patients undergoing total hip arthroplasty (THA). It is unclear how insulin use is correlated with risk for adverse outcomes. Methods: A cohort of 146,526 patients undergoing primary THA were identified in the 2005–2017 National Surgical Quality Improvement Program database. Patients were classified as insulin-dependent diabetic (IDDM), non-insulin-dependent diabetic (NIDDM), or not diabetic. Multivariate analyses were used. Results: Compared to patients without diabetes, patients with NIDDM were at increased risk for 4 of 17 perioperative adverse outcomes studied. Patients with IDDM were at increased risk for those 4 and 8 additional adverse outcomes (12 of the 17 studied). Conclusion: These findings have important implications for preoperative risk stratification and quality improvement initiatives.

scholarly journals Preoperative High, as well as Low, Platelet Counts Correlate With Adverse Outcomes After Elective Total Hip Arthroplasty

2020 ◽  
Vol 4 (9) ◽  
pp. e20.00049
Author(s):  
Rohil Malpani ◽  
Patawut Bovonratwet ◽  
Michael G. Clark ◽  
Taylor D. Ottesen ◽  
Michael R. Mercier ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Outcomes ◽  
Total Hip ◽  
Platelet Counts

Predicting Adverse Outcomes After Total Hip Arthroplasty

2018 ◽  
Vol 26 (20) ◽  
pp. 735-743 ◽  
Author(s):  
Nathaniel T. Ondeck ◽  
Daniel D. Bohl ◽  
Patawut Bovonratwet ◽  
Nidharshan S. Anandasivam ◽  
Jonathan J. Cui ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Adverse Outcomes ◽  
Total Hip

scholarly journals Development and internal validation of machine learning algorithms to predict patient satisfaction after total hip arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Siyuan Zhang ◽  
Jerry Yongqiang Chen ◽  
Hee Nee Pang ◽  
Ngai Nung Lo ◽  
Seng Jin Yeo ◽  
...  
Keyword(s):  
Machine Learning ◽  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Learning Algorithms ◽  
Machine Learning Algorithms ◽  
Support Vector ◽  
Lumbar Spine Surgery ◽  
Discriminative Ability ◽  
Total Hip

Abstract Background Patient satisfaction is a unique and important measure of success after total hip arthroplasty (THA). Our study aimed to evaluate the use of machine learning (ML) algorithms to predict patient satisfaction after THA. Methods Prospectively collected data of 1508 primary THAs performed between 2006 and 2018 were extracted from our joint replacement registry and split into training (80%) and test (20%) sets. Supervised ML algorithms (Random Forest, Extreme Gradient Boosting, Support Vector Machines, Logistic LASSO) were developed with the training set, using patient demographics, comorbidities and preoperative patient reported outcome measures (PROMs) (Short Form-36 [SF-36], physical component summary [PCS] and mental component summary [MCS], Western Ontario and McMaster’s Universities Osteoarthritis Index [WOMAC] and Oxford Hip Score [OHS]) to predict patient satisfaction at 2 years postoperatively. Predictive performance was evaluated using the independent test set. Results Preoperative models demonstrated fair discriminative ability in predicting patient satisfaction, with the LASSO model achieving a maximum AUC of 0.76. Permutation importance revealed that the most important predictors of dissatisfaction were (1) patient’s age, (2) preoperative WOMAC, (3) number of comorbidities, (4) preoperative MCS, (5) previous lumbar spine surgery, and (6) low BMI (< 18.5). Conclusion Machine learning algorithms demonstrated fair discriminative ability in predicting patient satisfaction after THA. We have identified modifiable and non-modifiable predictors of postoperative satisfaction which could enhance preoperative counselling and improve health optimization prior to THA.

Patients with Systemic Lupus Erythematosus Have Increased Risk of Short-term Adverse Events after Total Hip Arthroplasty

2016 ◽  
Vol 43 (8) ◽  
pp. 1498-1502 ◽  
Author(s):  
Jordan E. Roberts ◽  
Lisa A. Mandl ◽  
Edwin P. Su ◽  
David J. Mayman ◽  
Mark P. Figgie ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Renal Disease ◽  
Hip Arthroplasty ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Total Hip ◽  
Increased Risk ◽  
Comorbidity Scores

Objective.Total hip arthroplasty (THA) is performed more frequently in patients with systemic lupus erythematosus (SLE) than in the general population. However, whether patients with SLE have higher complication rates than patients with osteoarthritis (OA) is unknown. This study compares adverse events (AE) in SLE with OA controls.Methods.Patients in our institution’s registry were eligible. SLE was identified by the International Classification of Diseases, 9th ed code. AE were identified by chart review and questionnaire. Patients with SLE were matched with OA controls. Multivariate regression was performed to identify independent predictors of AE.Results.Fifty-eight patients with SLE THA were matched with 116 OA controls. Of the patients with SLE, 47.4% had Charlson-Deyo comorbidity scores (excluding SLE) > 1 versus 13.1% of OA (p < 0.0001). Length of stay was longer for SLE (6.0 days vs 4.7 days, p = 0.0008). Patients with SLE had more falls (10.3% vs 1.7%, p = 0.017), deep vein thrombosis (5.2% vs 0%, p = 0.036), acute renal disease (8.6% vs 0%, p = 0.004), wound infections (6.9% vs 0.9%, p = 0.043), and revision surgeries (5.2% vs 0%, p = 0.036). In a logistic regression controlling for comorbidities, SLE had an increased risk of AE (OR 3.77, 95% CI 1.74–8.16). Comorbidity scores were not significantly associated with AE. Among those with SLE, there were no significant differences in AE in those taking corticosteroids.Conclusion.SLE is an independent risk factor for AE after THA. Patients with SLE had higher rates of falls, acute renal disease, infections, and revision surgeries than matched OA controls. Further research is needed to understand the causes of increased AE in patients with SLE.

scholarly journals Fructosamine is a valuable marker for glycemic control and predicting adverse outcomes following total hip arthroplasty: a prospective multi-institutional investigation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Noam Shohat ◽  
Karan Goswami ◽  
Leigham Breckenridge ◽  
Michael B. Held ◽  
Arthur L. Malkani ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Joint Infection ◽  
Adverse Outcomes ◽  
International Consensus ◽  
Total Hip ◽  
Valuable Marker ◽  
Multi Center Study

AbstractRecently, fructosamine has shown promising results in predicting adverse outcomes following total knee arthroplasty. The purpose of this study was to assess the utility of fructosamine to predict adverse outcomes following total hip arthroplasty (THA). A prospective multi-center study involving four institutions was conducted. All primary THA were evaluated for glycemic control using fructosamine levels prior to surgery. Adverse outcomes were assessed at a minimum 1 year from surgery. Primary outcome of interest was periprosthetic joint infection (PJI) based on the International Consensus Meeting (ICM) criteria. Secondary outcomes assessed were superficial infections, readmissions and death. Based on previous studies on the subject, fructosamine levels above 293 µmol/L were used to define inadequate glycemic control. Overall 1212 patients were enrolled in the present study and were available for follow up at a minimum 1 year from surgery. Of those, 54 patients (4.5%) had elevated fructosamine levels (> 293 µmol/L) and these patients were 6.7 times more likely to develop PJI compared to patients with fructosamine levels below 293 µmol/L (p = 0.002). Patients with elevated fructosamine were also associated with more readmissions (16.7% vs. 4.4%, p < 0.007) and a higher mortality rate (3.7% vs. 0.6%, p = 0.057). These associations remained statistically significant in a multi-regression analysis after adjusting for age, comorbidities and length of stay; Adjusted odds ratio were 6.37 (95% confidence interval 1.98–20.49, p = 0.002) for PJI and 2.68 (95% confidence interval 1.14–6.29, p = 0.023) for readmissions. Fructosamine is a good predictor of adverse outcomes in patients undergoing THA and should be used routinely to mitigate morbidity and mortality risk.

scholarly journals Efficacy of continuous local cryotherapy following total hip arthroplasty

SICOT-J ◽  
2019 ◽  
Vol 5 ◽  
pp. 13
Author(s):  
Kentaro Iwakiri ◽  
Akio Kobayashi ◽  
Yuichi Takeuchi ◽  
Yusuke Kimura ◽  
Yoichi Ohta ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Total Hip Arthroplasty ◽  
Blood Loss ◽  
Hip Arthroplasty ◽  
Diclofenac Sodium ◽  
Adverse Outcomes ◽  
Control Group ◽  
Thigh Circumference ◽  
Total Hip ◽  
Estimated Blood Loss

Background: Cryotherapy is rarely reported on the usefulness of cryotherapy applied after total hip arthroplasty (THA), and there are no reports about patient satisfaction against the cryotherapy following THA. The aim of this study was whether cryotherapy can be useful for relieving pain, reducing blood loss, and swelling, and improving patient satisfaction after THA. Methods: Thirty patients who had undergone THA were treated by a controlled cooling device for 72 h following THA (defined as the cryotherapy group). The other 30 patients without cryotherapy were not treated with cryotherapy (defined as the control group). Blood samples (creatine kinase, and C-reactive protein), estimated blood loss, visual analog scale (VAS) of pain score, total doses of diclofenac sodium suppository used for pain relief, thigh swelling, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and adverse outcomes were compared between two groups. Results: Thigh circumference, measured on only day 4 postoperatively, was significantly lower in the cryotherapy than in the control group. Furthermore, patient satisfaction on postoperative days 4 and 7 was significantly higher in the cryotherapy than in the control group. There were no significant differences in other outcomes between groups. Conclusions: These results support the potential benefit of cryotherapy for the reduction of swelling, and patient satisfaction during postoperative recovery of patients undergoing THA, even in the presence of periarticular injection and tranexamic acid administration for the prevention of postoperative pain and bleeding. Postoperative cryotherapy is a potentially simple, noninvasive, and relatively inexpensive option for post-THA management.

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