Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Online First™

Articles

Increased Mortality After Prosthetic Joint Infection in Primary THA

Per Hviid Gundtoft MD, PhD, Alma Becic Pedersen MD, PhD, DMSc, Claus Varnum MD, PhD, Søren Overgaard MD, DMSc
24th February 2017, Clinical Research

Revision for prosthetic joint infection (PJI) has a major effect on patients’ health but it remains unclear if early PJI after primary THA is associated with a high mortality.

What Are the Frequency, Associated Factors, and Mortality of Amputation and Arthrodesis After a Failed Infected TKA?

Min-Sun Son PhD, Edmund Lau MS, Javad Parvizi MD, Michael A. Mont MD, Kevin J. Bozic MD, MBA, Steven Kurtz PhD
24th February 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

For patients with failed surgical treatment of an infected TKA, salvage operations such as arthrodesis or above-knee amputation (AKA) may be considered. Clinical and institutional factors associated with AKA and arthrodesis after a failed TKA have not been investigated in a large-scale population, and the utilization rate and trend of these measures are not well known.

Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

Steven M. Kurtz PhD, Edmund C. Lau MS, Kevin L. Ong PhD, Edward M. Adler MD, Frank R. Kolisek MD, Michael T. Manley FRSA, PhD
20th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

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.

High Risk of Readmission in Octogenarians Undergoing Primary Hip Arthroplasty

Arthur L. Malkani MD, Brian Dilworth MD, Kevin Ong PhD, Doruk Baykal PhD, Edmund Lau MS, Theresa N. Mackin BA, Gwo-Chin Lee MD
12th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

As life expectancy increases, more elderly patients with end-stage hip arthritis are electing to undergo primary THA. Octogenarians undergoing THA have more comorbidities than younger patients, but this is not reflected in risk adjustment models for bundled care programs. The burden of care associated with THA in octogenarians has not been well characterized, and doing so may help these value-based programs make adjustments so that this vulnerable patient population does not risk losing access under accountable care models.

Definitional Differences of ‘Outpatient’ Versus ‘Inpatient’ THA and TKA Can Affect Study Outcomes

Patawut Bovonratwet BS, Matthew L. Webb MD, MHS, Nathaniel T. Ondeck BS, Adam M. Lukasiewicz MD, MSc, Jonathan J. Cui BS, Ryan P. McLynn BS, Jonathan N. Grauer MD
12th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

There has been great interest in performing outpatient THA and TKA. Studies have compared such procedures done as outpatients versus inpatients. However, stated “outpatient” status as defined by large national databases such as the National Surgical Quality Improvement Program (NSQIP) may not be a consistent entity, and the actual lengths of stay of those patients categorized as outpatients in NSQIP have not been specifically ascertained and may in fact include some patients who are “observed” for one or more nights. Current regulations in the United States allow these “observed” patients to stay more than one night at the hospital under observation status despite being coded as outpatients. Determining the degree to which this is the case, and what, exactly, “outpatient” means in the NSQIP, may influence the way clinicians read studies from that source and the way hospital systems and policymakers use those data.

Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Andrew J. Schoenfeld MD, MSc, Heeren Makanji MD, Wei Jiang MS, Tracey Koehlmoos PhD, Christopher M. Bono MD, Adil H. Haider MD, MPH
10th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated.

What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

Daniel D. Bohl MD, MPH, Nathaniel T. Ondeck BS, Bryce A. Basques MD, Brett R. Levine MD, Jonathan N. Grauer MD
4th January 2017, Symposium: Learning From Large-Scale Orthopaedic Databases

Despite extensive research regarding risk factors for adverse events after total joint arthroplasty (TJA), there are few publications describing the timing at which such adverse events occur.

Perioperative Risk Adjustment for Total Shoulder Arthroplasty: Are Simple Clinically Driven Models Sufficient?

David N. Bernstein MA, Aakash Keswani BA, David Ring MD, PhD
30th November 2016, Symposium: Learning From Large-Scale Orthopaedic Databases

There is growing interest in value-based health care in the United States. Statistical analysis of large databases can inform us of the factors associated with and the probability of adverse events and unplanned readmissions that diminish quality and add expense. For example, increased operating time and high blood urea nitrogen (BUN) are associated with adverse events, whereas patients on antihypertensive medications were more likely to have an unplanned readmission. Many surgeons rely on their knowledge and intuition when assessing the risk of a procedure. Comparing clinically driven with statistically derived risk models of total shoulder arthroplasty (TSA) offers insight into potential gaps between common practice and evidence-based medicine.