Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017

Mohamad J Halawi; Christian Gronbeck; Mark L Metersky; Yun Wang; Sheila Eckenrode; Jasie Mathew; Lisa G Suter; Noel Eldridge

doi:10.1016/j.artd.2021.08.010

Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017

Arthroplast Today. 2021 Sep 22:11:157-162. doi: 10.1016/j.artd.2021.08.010. eCollection 2021 Oct.

Authors

Mohamad J Halawi¹, Christian Gronbeck², Mark L Metersky², Yun Wang³, Sheila Eckenrode⁴, Jasie Mathew⁴, Lisa G Suter⁴, Noel Eldridge⁵

Affiliations

¹ Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.
² Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, CT, USA.
³ Division of Cardiology, Beth Israel Deaconess Medical and Harvard Medical School, Boston, MA, USA.
⁴ Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation, New Haven, CT, USA.
⁵ Agency for Healthcare Research and Quality, Rockville, MD, USA.

Abstract

Background: Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA.

Methods: 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated changes in demographics, comorbidities, and adverse events (AEs) over time. Risk factors for AEs were also assessed.

Results: Between 2010 and 2017, there was an increased prevalence of obesity (35.1% to 57.6%), tobacco smoking (12.5% to 17.8%), and renal disease (5.2% to 8.9%). There were reductions in coronary artery disease (17.3% to 13.4%) and chronic warfarin use (6.7% to 3.1%). Inpatient AEs decreased from 4.9% to 2.5%, (P < .01), primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas (from 2.8% to 1.0%, P < .001), catheter-associated urinary tract infections (1.1% to 0.2%, P < .001), pressure ulcers (0.8% to 0.2%, P < .001), and venous thromboembolism (0.3% to 0.1%, P = .04). The adjusted annual decline in the risk of developing any in-hospital AE was 14% (95% confidence interval [CI] 10%-17%). Factors associated with developing an AE were advanced age (odds ratio [OR] = 1.01, 95% CI 1.00-1.01), male sex (OR = 1.21, 95% CI 1.02-1.44), coronary artery disease (OR = 1.35, 95% CI 1.07-1.70), heart failure (OR = 1.70, 95% CI 1.20-2.41), and renal disease (OR = 1.71, 95% CI 1.23-2.37).

Conclusions: Despite increasing prevalence of obesity, tobacco smoking, and renal disease, inpatient AEs after primary TKA have decreased over the past several years. This improvement is despite the increasing complexity of the inpatient TKA population over time.

Keywords: Adverse events; Knee arthroplasty; Patient safety; Risk factors; Time trends.