Periprosthetic tibial fractures in total knee arthroplasty - an outcome analysis of a challenging and underreported surgical issue.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the local ethics committee (622/2015B02) at the Faculty of Medicine at the Eberhard Karls University and the Medical Center, Tübingen, Gartenstrasse 47, 72,074 Tübingen and written consent to participate was obtained from all participants. CONSENT FOR PUBLICATION: Not applicable. COMPETING INTERESTS: The authors declare that they have no competing interests. PUBLISHER’S NOTE: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 13. Clin Orthop Relat Res. 2017 Dec;475(12):2926-2937. doi: 10.1007/s11999-017-5244-6. Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty? Kurtz SM(1)(2), Lau EC(3), Ong KL(4), Adler EM(5), Kolisek FR(6), Manley MT(7). Author information: (1)Exponent Inc, 3440 Market Street, Suite 600, Philadelphia, PA, 19104, USA. skurtz@exponent.com. (2)School of Biomedical Engineering, Science, and Health Systems, Drexel University, Philadelphia, PA, USA. skurtz@exponent.com. (3)Exponent Inc, Menlo Park, CA, USA. (4)Exponent Inc, 3440 Market Street, Suite 600, Philadelphia, PA, 19104, USA. (5)Hospital for Joint Diseases, New York, NY, USA. (6)OrthoIndy, Indianapolis, IN, USA. (7)Stryker Orthopaedics, Mahwah, NJ, USA. Comment in Clin Orthop Relat Res. 2017 Dec;475(12):2938-2940. doi: 10.1007/s11999-017-5324-7. BACKGROUND: The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. QUESTIONS/PURPOSES: (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? METHODS: The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes. We classified the reasons for readmissions as either procedure- or medical-related. Cost-to-charge ratios supplied with the Nationwide Readmissions Database were used to compute the individual per-patient cost of 90-day readmissions as a continuous variable in separate general linear models for THA and TKA. Payer, patient, clinical, and hospital factors were treated as covariates. We estimated the national burden of readmissions by payer and by the reason for readmission. RESULTS: The national rates of 30- and 90-day readmissions after THA were 4% (95% confidence interval [CI], 4.2%-4.5%) and 8% (95% CI, 7.5%-8.1%), respectively. The national rates of 30- and 90-day readmissions after primary TKA were 4% (95% CI, 3.8%-4.0%) and 7% (95% CI, 6.8%-7.2%), respectively. The five most important variables responsible for the cost of 90-day THA readmissions (in rank order, based on the Type III F-statistic, p