Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

Abstract

Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299–7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients

“…The literature on the relationship between CCI score and post-TKA mortality is sparse yet consistent in finding a significant association between high CCI score with increased mortality risk. 4 40 Buitrago et al 4 conducted a study of 12,453 TKA patients and found that those with a CCI score ≥ 3 had a 30-day mortality odds ratio of 7.59 (95% CI: 1.79–32.10, p = 0.01). Of note, this study included all TKA procedures inclusive of revision and emergent procedures and was conducted with a Colombian patient population.…”

“…Total knee arthroplasty (TKA) is a widely utilized procedure with excellent functional outcomes and long-term survivorship. 1 2 3 4 5 Although mortality after TKA is rare, it remains an ever-present concern given its catastrophic nature and potential for aversion through nonoperative management. Thirty-day mortality rates between 0.17 6 and 0.5% 7 following primary elective TKA have been reported in the literature.…”

Mortalidad perioperatoria en Tolima, perspectivas del cuarto indicador de The Lancet Commission on Global Surgery: un análisis preliminar de la cohorte prospectiva del estudio Colombian Surgical Outcomes Study (ColSOS)

“…En este análisis inicial relacionamos la tasa de mortalidad perioperatoria en el departamento de Tolima. Este abordaje permite obtener datos más actualizados y representativos en nuestro territorio, en contraste con la evidencia que ofrecen los estudios retrospectivos 5,[18][19][20][21] .…”

Association of healthcare fragmentation and the survival of patients with colorectal cancer in Colombia

“…This database contains detailed information about all health services that are used by the individuals in the contributory system, and includes the identi cation of the type of service provided, the associated ICD-10 code, the cost paid by the insurer, the date of service, the municipality and the provider. This database is highly standardized, has little underreporting of the health services provided to the enrolled population and has already been used in other national studies (25)(26)(27)(28)(29)(30)(31)(32). 2) Another source of information that was used was the Unique Enrollee Database (BDUA in Spanish), which contains information about all enrollees in the health system, including enrollment status, age, sex, insurer and the health system in which the person was enrolled.…”