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• W4249194240 abstract "Purpose: Hospitals and surgeons continue to be under increased cost pressure with respect to total knee arthroplasty (TKA), with increasing material costs and decreasing reimbursements. Recent evidence suggests that multiple symptomatic joint involvement in patients with osteoarthritis (OA) may be associated with poorer patient reported outcomes when compared to those who have a single symptomatic joint. However, it remains unclear whether this is associated with any differences in in-hospital resource utilization. The purpose of the present study was to evaluate whether the presence of multiple symptomatic joints is associated with differences in length of stay, discharge disposition, American Society of Anesthesiologists (ASA) class, post-operative adverse event rates, or episode of care costs from the hospital perspective in patients undergoing primary TKA for OA. Methods: All patients who underwent primary TKA for OA at a single institution between April 2011 and October 2012 were reviewed. Patients with a history of rheumatoid arthritis or inflammatory arthropathy were excluded, as were patients undergoing bilateral procedures. Prospectively collected demographic and clinical data, including number and location of symptomatic joints, as well as ASA class and discharge disposition were extracted. Data were liked with a hospital administrative costing database. Post-operative adverse event rates were tracked prospectively and included in the analysis. Patients were grouped into three categories based on joint involvement: 1) symptoms in the operated joint only, 2) symptoms in a total of 2–4 joints, and 3) five or more symptomatic joints. A total of 245 patients were included, with 35, 99, and 111 in each group, respectively. Results: Significant differences were seen in mean length-of-stay between patient groups (3.74, 3.96 and 4.19 days respectively; p = 0.042), with longer time to discharge in patients with multiple joint involvement. These differences were maintained when patients discharged to rehabilitation facilities were excluded (p = 0.015), and were not explained by differences in mean patient age (64, 65 and 65 years of age respectively; p = 0.925), the need for stair training before discharge home (93%, 93% and 86% of patients; p = 0.290), or in-hospital adverse event rates (p = 0.315). No significant differences in the proportion of patients discharged to home were identified based on degree of multi-joint involvement (83%, 81% and 76% respectively; p = 0.540). Multiple joint involvement was positively associated with increasing mean ASA class (2.26, 2.33, 2.61 respectively; p < 0.001), but was not correlated with the incidence of in-hospital adverse events (r = 0.012). Increasing joint involvement was associated with significantly greater mean episode of care costs from a hospital perspective (p = 0.024), and this relationship was maintained when the analysis was limited to patients who were discharged home (p = 0.011). Patients with involvement of 5 or more joints accrued an incremental 9% cost burden to the hospital when compared to those with single joint disease ($10,251 vs $9,379 per patient). Assuming a similar nation-wide prevalence of multiple joint symptoms, this represents a total incremental cost burden of $19,500,000 per year to the Canadian health care system based on 2008/2009 nationwide case volumes. Conclusions: The results of the present study provide evidence of differences in in-hospital health resource utilization following TKA for OA between patients who have multiple symptomatic joints when compared to those with a minimal number of symptomatic joints. These patients appear to have a greater severity of systemic disease as evidenced by greater mean ASA scores, although this did not translate into an increased risk of post-operative in-hospital adverse events. While no significant differences were seen in discharge disposition, patients with multiple symptomatic joints spent an average of half a day longer in hospital before discharge when compared to those with symptoms in the operated joint only, and accrued almost 10% greater costs from the hospital perspective. Physicians and other health care decision makers should be aware that multi-joint OA may characterize a distinct clinical entity that may warrant specific attention." @default.
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• W4249194240 date "2014-04-01" @default.
• W4249194240 modified "2023-09-29" @default.
• W4249194240 title "Multiple symptomatic joints are associated with increased health resource utilization among patients undergoing total knee arthroplasty for osteoarthritis" @default.
• W4249194240 doi "https://doi.org/10.1016/j.joca.2014.02.429" @default.
• W4249194240 hasPublicationYear "2014" @default.
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