Estimating Risk in Medicare Patients With THA: An Electronic Risk Calculator for Periprosthetic Joint Infection and Mortality
- 1 February 2013
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 471 (2), 574-583
- https://doi.org/10.1007/s11999-012-2605-z
Abstract
Although risk factors for periprosthetic joint infection (PJI) and mortality after total hip arthroplasty (THA) have been identified, interactions between specific patient risk factors are poorly understood. Therefore, it is difficult for surgeons to counsel patients on their individual risk of PJI or mortality after THA. We evaluated the interaction between patient clinical and demographic factors on the risk of PJI and mortality after THA and developed an electronic risk calculator for estimating the patient-specific risk of PJI and mortality in Medicare patients with THA. We used the Medicare 5% sample claims database to calculate the risk of PJI within 2 years and mortality within 90 days after THA in 53,252 Medicare patients with primary THAs between 1998 and 2009. Logistic regression using 29 comorbid conditions, age, sex, race, and socioeconomic status were used as inputs to develop an electronic risk calculator to estimate patient-specific risk of PJI and mortality after THA. The overall 2-year risk of PJI and 90-day risk of mortality after primary THA were 2.07% and 1.30%, respectively. White women aged 70 to 74 years with alcohol abuse, depression, electrolyte disorder, peptic ulcer disease, urinary tract infection, rheumatologic disease, preoperative anemia, cardiopulmonary (cardiac arrhythmia, congestive heart failure, ischemic heart disease, chronic pulmonary disease) comorbidities, and peripheral vascular disease were at highest risk for PJI. White women aged 65 to 69 years with electrolyte disorder, hemiplegia/paraplegia, hypertension, hypothyroidism, metastatic tumor, preoperative anemia, coagulopathy, cardiopulmonary (congestive heart failure, chronic pulmonary disease) and psychiatric (psychoses, depression) comorbidities, malignancies, and peripheral vascular disease were at highest risk for mortality. An electronic risk calculator was developed to estimate the risk of PJI and mortality in Medicare patients with THA. This electronic risk calculator can be used to counsel Medicare patients regarding their patient-specific risks of PJI and mortality after THA. Level II, prognostic study. See the Instructions for Authors for a complete description of levels of evidence.Keywords
This publication has 15 references indexed in Scilit:
- Patient-related Risk Factors for Postoperative Mortality and Periprosthetic Joint Infection in Medicare Patients Undergoing TKAClinical Orthopaedics & Related Research, 2012
- Smartphone App Use Among Medical Providers in ACGME Training ProgramsJournal of Medical Systems, 2011
- Quality of life and functionality after total hip arthroplasty: a long-term follow-up studyBMC Musculoskeletal Disorders, 2011
- Smartphone Apps for Orthopaedic SurgeonsClinical Orthopaedics & Related Research, 2011
- Total hip or knee replacement for osteoarthritis: Mid‐ and long‐term quality of lifeArthritis Care & Research, 2009
- Prosthetic Joint Infection Risk After Total Hip Arthroplasty in the Medicare PopulationThe Journal of Arthroplasty, 2009
- Joint Replacement Surgery in Elderly Patients With Severe Osteoarthritis of the Hip or KneeDecision Making, Postoperative Recovery, and Clinical OutcomesArchives of Internal Medicine, 2008
- Does a history of cardiac disease or hypertension increase mortality following primary elective total hip arthroplasty?The Surgeon, 2007
- Presence of Medical Comorbidities in Patients With Infected Primary Hip or Knee ArthroplastiesThe Journal of Arthroplasty, 2007
- Frequency of Myocardial Infarction, Pulmonary Embolism, Deep Venous Thrombosis, and Death following Primary Hip or Knee ArthroplastyAnesthesiology, 2002