Elsevier

The Journal of Arthroplasty

Volume 18, Issue 6, September 2003, Pages 693-708
The Journal of Arthroplasty

Preoperative risks and outcomes of hip and knee arthroplasty in the veterans health administration1 ,

https://doi.org/10.1016/S0883-5403(03)00259-6Get rights and content

Abstract

The relationship between patient characteristics and outcomes of total joint arthroplasty (TJA) was examined in a population of veterans treated in VA hospitals. Outcomes included 30-day mortality and morbidity, postoperative length of stay, and readmission caused by surgical complications. A larger proportion of women then men were functionally impaired before surgery in both the hip (22% vs. 14%) and knee samples (14% vs. 7%; all P<.01). Rates of adverse outcomes in this population were very low. Preoperative comorbid conditions, abnormal laboratory values, and being nonwhite were related to poor outcomes of TJA. Gender was a significant independent predictor of morbidity and length of stay for total knee arthroplasty.

Section snippets

Materials and methods

This study reports on the findings of 6,876 THAs and 11,710 TKAs performed in VA hospitals between October 1991 and September 1997. Data sources included the VA National Surgical Quality Improvement Program (NSQIP) 11, 12, 13, 14, 15 and a set of national inpatient discharge databases, known as the VHA Inpatient Medical SAS datasets 16, 17 that contain details on hospital admissions including admission and discharge dates, diagnostic codes, and surgery and procedure information.

The NSQIP,

Hip replacement

A total of 6,876 THA procedures were identified in the database; 2.6% (n = 180) were for women (Table 2). Several significant differences were noted between males and females in the sample, including age, race, and martial status. Females were older, more often white, and less likely to be married (all P<.05) than males. Risk factors including smoking and alcohol use were higher in the male sample. However, females were more likely to be functionally dependent (based on nurse assessment)

Discussion

This project examined preoperative surgical risks and outcomes for 2 procedures common among men and women (i.e., hip and knee arthroplasty) using prospectively collected quality-improvement data supplemented with inpatient discharge data. Not surprisingly, the presence of comorbid conditions, longer time in the operating room, abnormal laboratory values, and cases considered to be higher risk were associated with increased postoperative LOS and 30-day morbidity. Race was also a significant

Acknowledgements

The authors acknowledge the invaluable input and support of Drs. James Gibbs, Kevin Stroupe, Kwan Hur, Elly Budiman-Mak, Hassan Alissa, and Aqueel Kouser; the programming support of Bharat Thakkar; and the project-management skills of Dolores Ippolito.

References (31)

  • C. MacWilliams et al.

    Patient-related risk factors that predict poor outcome after total hip replacement

    Health Serv Res

    (1996)
  • G. Riley et al.

    Medical beneficiariesadverse outcomes after hospitalization for eight procedures

    Medical Care

    (1993)
  • D. Heck et al.

    Revision rates after knee replacement in the United States

    Medical Care

    (1998)
  • J. Katz et al.

    Differences between men and women undergoing major orthopedic surgery for degenerative arthritis

    Arthritis Rheum

    (1994)
  • G. Hawker et al.

    Differences between men and women in the rate of use of hip and knee arthroplasty

    N Engl J Med

    (2000)
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      Lower education level,147,148 low income,145 and Medicaid insurance149,150 are associated with worse function after TJA. Patients who are nonwhite151–153 or with low SES have a higher risk for longer length of stay after TJA.154–156 Black and Hispanic patients have higher complication rates after arthroplasty.

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    Supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service, as project GEN 97–016.

    1

    The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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