Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017

Background: Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA. Methods: 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated cha...

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Autores principales:	Mohamad J. Halawi, MD, Christian Gronbeck, BS, Mark L. Metersky, MD, Yun Wang, PhD, Sheila Eckenrode, MA, RN, Jasie Mathew, MBA, Lisa G. Suter, MD, Noel Eldridge, MS
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Adverse events Knee arthroplasty Patient safety Risk factors Time trends Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/83db73fc859d44dd89651aff18500e3b
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spelling	oai:doaj.org-article:83db73fc859d44dd89651aff18500e3b2021-11-14T04:34:01ZTime Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-20172352-344110.1016/j.artd.2021.08.010https://doaj.org/article/83db73fc859d44dd89651aff18500e3b2021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001515https://doaj.org/toc/2352-3441Background: Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA. Methods: 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated changes in demographics, comorbidities, and adverse events (AEs) over time. Risk factors for AEs were also assessed. Results: Between 2010 and 2017, there was an increased prevalence of obesity (35.1% to 57.6%), tobacco smoking (12.5% to 17.8%), and renal disease (5.2% to 8.9%). There were reductions in coronary artery disease (17.3% to 13.4%) and chronic warfarin use (6.7% to 3.1%). Inpatient AEs decreased from 4.9% to 2.5%, (P < .01), primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas (from 2.8% to 1.0%, P < .001), catheter-associated urinary tract infections (1.1% to 0.2%, P < .001), pressure ulcers (0.8% to 0.2%, P < .001), and venous thromboembolism (0.3% to 0.1%, P = .04). The adjusted annual decline in the risk of developing any in-hospital AE was 14% (95% confidence interval [CI] 10%-17%). Factors associated with developing an AE were advanced age (odds ratio [OR] = 1.01, 95% CI 1.00-1.01), male sex (OR = 1.21, 95% CI 1.02-1.44), coronary artery disease (OR = 1.35, 95% CI 1.07-1.70), heart failure (OR = 1.70, 95% CI 1.20-2.41), and renal disease (OR = 1.71, 95% CI 1.23-2.37). Conclusions: Despite increasing prevalence of obesity, tobacco smoking, and renal disease, inpatient AEs after primary TKA have decreased over the past several years. This improvement is despite the increasing complexity of the inpatient TKA population over time.Mohamad J. Halawi, MDChristian Gronbeck, BSMark L. Metersky, MDYun Wang, PhDSheila Eckenrode, MA, RNJasie Mathew, MBALisa G. Suter, MDNoel Eldridge, MSElsevierarticleAdverse eventsKnee arthroplastyPatient safetyRisk factorsTime trendsOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 157-162 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Adverse events Knee arthroplasty Patient safety Risk factors Time trends Orthopedic surgery RD701-811
spellingShingle	Adverse events Knee arthroplasty Patient safety Risk factors Time trends Orthopedic surgery RD701-811 Mohamad J. Halawi, MD Christian Gronbeck, BS Mark L. Metersky, MD Yun Wang, PhD Sheila Eckenrode, MA, RN Jasie Mathew, MBA Lisa G. Suter, MD Noel Eldridge, MS Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017
description	Background: Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA. Methods: 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated changes in demographics, comorbidities, and adverse events (AEs) over time. Risk factors for AEs were also assessed. Results: Between 2010 and 2017, there was an increased prevalence of obesity (35.1% to 57.6%), tobacco smoking (12.5% to 17.8%), and renal disease (5.2% to 8.9%). There were reductions in coronary artery disease (17.3% to 13.4%) and chronic warfarin use (6.7% to 3.1%). Inpatient AEs decreased from 4.9% to 2.5%, (P < .01), primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas (from 2.8% to 1.0%, P < .001), catheter-associated urinary tract infections (1.1% to 0.2%, P < .001), pressure ulcers (0.8% to 0.2%, P < .001), and venous thromboembolism (0.3% to 0.1%, P = .04). The adjusted annual decline in the risk of developing any in-hospital AE was 14% (95% confidence interval [CI] 10%-17%). Factors associated with developing an AE were advanced age (odds ratio [OR] = 1.01, 95% CI 1.00-1.01), male sex (OR = 1.21, 95% CI 1.02-1.44), coronary artery disease (OR = 1.35, 95% CI 1.07-1.70), heart failure (OR = 1.70, 95% CI 1.20-2.41), and renal disease (OR = 1.71, 95% CI 1.23-2.37). Conclusions: Despite increasing prevalence of obesity, tobacco smoking, and renal disease, inpatient AEs after primary TKA have decreased over the past several years. This improvement is despite the increasing complexity of the inpatient TKA population over time.
format	article
author	Mohamad J. Halawi, MD Christian Gronbeck, BS Mark L. Metersky, MD Yun Wang, PhD Sheila Eckenrode, MA, RN Jasie Mathew, MBA Lisa G. Suter, MD Noel Eldridge, MS
author_facet	Mohamad J. Halawi, MD Christian Gronbeck, BS Mark L. Metersky, MD Yun Wang, PhD Sheila Eckenrode, MA, RN Jasie Mathew, MBA Lisa G. Suter, MD Noel Eldridge, MS
author_sort	Mohamad J. Halawi, MD
title	Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017
title_short	Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017
title_full	Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017
title_fullStr	Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017
title_full_unstemmed	Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017
title_sort	time trends in patient characteristics and in-hospital adverse events for primary total knee arthroplasty in the united states: 2010-2017
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/83db73fc859d44dd89651aff18500e3b
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Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017

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