PDF herunterladen
J Knee Surg 2018; 31(04): 291-301
DOI: 10.1055/s-0037-1603335
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hematologic Malignancies Are Associated with Adverse Perioperative Outcomes following Total Knee Arthroplasty

Jared M. Newman
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Timothy C. Wagner
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Qais Naziri
2   Department of Orthopaedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York
,
W. Trevor North
3   Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan
,
Suparna M. Navale
4   Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
,
Alison K. Klika
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Wael K. Barsoum
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
,
Carlos A. Higuera
1   Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
› Institutsangaben
Weitere Informationen

Publikationsverlauf

16. Januar 2017

31. März 2017

Publikationsdatum:
23. Mai 2017 (online)

    Lizenzen und Reprints

Abstract

The treatment of hematologic malignancies has advanced over the years, resulting in an improved survival of patients. As a result, these patients may be a part of the increasing population requiring total knee arthroplasty (TKA); however, they might be at a higher risk of adverse perioperative outcomes. The purpose of this study was to determine the perioperative outcomes (complications, length of stay [LOS], and costs) of patients with hematologic malignancies following TKA. This study used the Nationwide Inpatient Sample (NIS) to identify patients who underwent TKA in the United States from 2000 to 2011. Patients diagnosed with any hematologic malignancy (N = 24,714) were then stratified by Hodgkin's disease (N = 791), Non-Hodgkin's lymphoma (N = 7,096), plasma cell dyscrasias (N = 1,621), leukemia (N = 8,005), myeloproliferative disease (N = 5,746), and/or myelodysplastic syndromes (N = 1,608) for determining the complications that occurred during admission. Propensity matching was performed for demographics, hospital characteristics, and comorbidities, which yielded 24,491 patients with any hematologic malignancy and 24,458 control patients. Additionally, propensity matching was performed for the hematologic malignancy subtypes. Multivariable regression models were used to analyze the surgical and medical complications, LOS, and costs. The annual frequency of THA in patients with any hematologic malignancy increased from 2000 to 2011 (p < 0.0001). Hematologic malignancies were associated with an increased risk of any surgery-related complication (odds ratio [OR] = 1.31, p < 0.0001) and any general medical complication (OR = 1.38, p < 0.0001). Patients with any hematologic malignancy had increased odds of complications, including acute postoperative anemia (OR = 1.29, p < 0.0001), hematoma/seroma (OR = 1.65, p < 0.02), peripheral vascular disease (OR = 2.23, p = 0.046), deep venous thrombosis (DVT) (OR = 1.95, p = 0.02), and blood transfusion (OR = 1.61, p < 0.0001). Hematologic malignancies were associated with an increased incremental LOS (0.13 d, p < 0.0001) and an increased incremental cost ($788, p < 0.0001). Thus, we conclude that following TKA, patients with hematologic malignancies are at an increased risk of perioperative complications, longer LOS, and higher costs. The risk quantification for adverse perioperative outcomes in association with an increased cost may help design different risk stratification and reimbursement methods in such patients when undergoing TKA.

Keywords

total knee arthroplasty - hematologic malignancy - perioperative outcomes - length of stay - costs
 

  • References

  • 1 American Cancer Society. Cancer Facts & Figures 2015. Atlanta: American Cancer Society; 2015
    Google Scholar
  • 2 Vardiman JW, Thiele J, Arber DA. , et al. The 2008 revision of the World Health Organization (WHO) classification of myeloid neoplasms and acute leukemia: rationale and important changes. Blood 2009; 114 (05) 937-951
    CrossrefPubMedGoogle Scholar
  • 3 Alexander DD, Mink PJ, Adami HO. , et al. The non-Hodgkin lymphomas: a review of the epidemiologic literature. Int J Cancer 2007; 120 (Suppl. 12) 1-39
    PubMedGoogle Scholar
  • 4 Alexander DD, Mink PJ, Adami HO. , et al. Multiple myeloma: a review of the epidemiologic literature. Int J Cancer 2007; 120 (Suppl. 12) 40-61
    CrossrefPubMedGoogle Scholar
  • 5 Langston AA, Walling R, Winton EF. Update on myelodysplastic syndromes: new approaches to classification and therapy. Semin Oncol 2004; 31 (02) (Suppl. 04) 72-79
    CrossrefPubMedGoogle Scholar
  • 6 Pulte D, Gondos A, Brenner H. Expected long-term survival of older patients diagnosed with non-Hodgkin lymphoma in 2008-2012. Cancer Epidemiol 2012; 36 (01) e19-e25
    CrossrefPubMedGoogle Scholar
  • 7 Brenner H, Gondos A, Pulte D. Expected long-term survival of patients diagnosed with multiple myeloma in 2006-2010. Haematologica 2009; 94 (02) 270-275
    CrossrefPubMedGoogle Scholar
  • 8 Brenner H, Gondos A, Pulte D. Survival expectations of patients diagnosed with Hodgkin's lymphoma in 2006-2010. Oncologist 2009; 14 (08) 806-813
    CrossrefPubMedGoogle Scholar
  • 9 Xie Y, Davies SM, Xiang Y, Robison LL, Ross JA. Trends in leukemia incidence and survival in the United States (1973-1998). Cancer 2003; 97 (09) 2229-2235
    CrossrefPubMedGoogle Scholar
  • 10 Srour SA, Devesa SS, Morton LM. , et al. Incidence and patient survival of myeloproliferative neoplasms and myelodysplastic/myeloproliferative neoplasms in the United States, 2001-12. Br J Haematol 2016; 174 (03) 382–396
    PubMedGoogle Scholar
  • 11 Calabro JJ. Cancer and arthritis. Arthritis Rheum 1967; 10 (06) 553-567
    CrossrefPubMedGoogle Scholar
  • 12 Spilberg I, Meyer GJ. The arthritis of leukemia. Arthritis Rheum 1972; 15 (06) 630-635
    CrossrefPubMedGoogle Scholar
  • 13 Thomas LB, Forkner Jr CE, Frei III E, Besse Jr BE, Stabenau Jr. The skeletal lesions of acute leukemia. Cancer 1961; 14: 608-621
    CrossrefPubMedGoogle Scholar
  • 14 Evans TI, Nercessian BM, Sanders KM. Leukemic arthritis. Semin Arthritis Rheum 1994; 24 (01) 48-56
    CrossrefPubMedGoogle Scholar
  • 15 Engel IA, Straus DJ, Lacher M, Lane J, Smith J. Osteonecrosis in patients with malignant lymphoma: a review of twenty-five cases. Cancer 1981; 48 (05) 1245-1250
    CrossrefPubMedGoogle Scholar
  • 16 Mould JJ, Adam NM. The problem of avascular necrosis of bone in patients treated for Hodgkin's disease. Clin Radiol 1983; 34 (02) 231-236
    CrossrefPubMedGoogle Scholar
  • 17 Prosnitz LR, Lawson JP, Friedlaender GE, Farber LR, Pezzimenti JF. Avascular necrosis of bone in Hodgkin's disease patients treated with combined modality therapy. Cancer 1981; 47 (12) 2793-2797
    CrossrefPubMedGoogle Scholar
  • 18 Talamo G, Angtuaco E, Walker RC. , et al. Avascular necrosis of femoral and/or humeral heads in multiple myeloma: results of a prospective study of patients treated with dexamethasone-based regimens and high-dose chemotherapy. J Clin Oncol 2005; 23 (22) 5217-5223
    CrossrefPubMedGoogle Scholar
  • 19 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 20 Niinimäki TT, Ohtonen P, Harila-Saari AH, Niinimäki RA. Young patients with hematologic and lymphatic malignancies have an increased risk of hip and knee arthroplasty. Acta Oncol 2016; 55 (05) 567-571
    CrossrefPubMedGoogle Scholar
  • 21 McGrory BJ, Trousdale RT. Total hip arthroplasty in patients who have chronic lymphocytic leukemia. J Arthroplasty 1995; 10 (06) 758-763
    CrossrefPubMedGoogle Scholar
  • 22 Katz JN, Brick GW, Rudd R. Elective palliative total hip replacement in a patient with lymphoma and advanced lung cancer. Arthritis Rheum 2008; 59 (08) 1194-1196
    CrossrefPubMedGoogle Scholar
  • 23 Menendez ME, Park KJ, Barnes CL. Early postoperative outcomes after total joint arthroplasty in patients with multiple myeloma. J Arthroplasty 2016; 31 (08) 1645-1648
    CrossrefPubMedGoogle Scholar
  • 24 Nationwide Inpatient Sample HCUP. (NIS). Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality; 2013
    Google Scholar
  • 25 Newman JM, Schiltz NK, Mudd CD, Szubski CR, Klika AK, Barsoum WK. Impact of cirrhosis on resource use and inpatient complications in patients undergoing total knee and hip arthroplasty. J Arthroplasty 2016; 31 (11) 2395-2401
    CrossrefPubMedGoogle Scholar
  • 26 Klika AK, Small TJ, Saleh A, Szubski CR, Chandran Pillai ALP, Barsoum WK. Primary total knee arthroplasty allogenic transfusion trends, length of stay, and complications: nationwide inpatient sample 2000-2009. J Arthroplasty 2014; 29 (11) 2070-2077
    CrossrefPubMedGoogle Scholar
  • 27 Best MJ, Buller LT, Klika AK, Barsoum WK. Increase in perioperative complications following primary total hip and knee arthroplasty in patients with hepatitis C without cirrhosis. J Arthroplasty 2015; 30 (04) 663-668
    CrossrefPubMedGoogle Scholar
  • 28 Cost-to-Charge Ratio Files. Healthcare Cost and Utilization Project (HCUP). Rockville, MD: Agency for Healthcare Research and Quality. 2014. Available at: https://www.hcup-Us.ahrq.gov/db/state/costtocharge.jsp . Accessed September 4, 2015
    PubMedGoogle Scholar
  • 29 HCUP Comorbidity Software. Healthcare cost and utilization project (HCUP). Agency for Healthcare Research and Quality. 2002–2013. Available at: https://www.lls.org/sites/default/files/file_assets/facts.pdf
    PubMedGoogle Scholar
  • 30 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
    CrossrefPubMedGoogle Scholar
  • 31 Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behav Res 2011; 46 (03) 399-424
    CrossrefPubMedGoogle Scholar
  • 32 Facts 2014–2015: Leukemia & Lymphoma Society. . Available at: https://www.lls.org/sites/default/files/file_assets/facts.pdf . Accessed May 10, 2017
    PubMed
  • 33 Karimova EJ, Wozniak A, Wu J, Neel MD, Kaste SC. How does osteonecrosis about the knee progress in young patients with leukemia?: a 2- to 7-year study. Clin Orthop Relat Res 2010; 468 (09) 2454-2459
    CrossrefPubMedGoogle Scholar
  • 34 Niinimäki R, Hansen LM, Niinimäki T. , et al. Incidence of Severe Osteonecrosis Requiring Total Joint Arthroplasty in Children and Young Adults Treated for Leukemia or Lymphoma: A Nationwide, Register-Based Study in Finland and Denmark. J Adolesc Young Adult Oncol 2013; 2 (04) 138-144
    CrossrefPubMedGoogle Scholar
  • 35 Bozic KJ, Bashyal RK, Anthony SG, Chiu V, Shulman B, Rubash HE. Is administratively coded comorbidity and complication data in total joint arthroplasty valid?. Clin Orthop Relat Res 2013; 471 (01) 201-205
    CrossrefPubMedGoogle Scholar
  • 36 Lee ES, Hibsman BK, Liebman HA. Acquired bleeding disorder in a patient with malignant lymphoma: antibody-mediated prothrombin deficiency. Cancer 2001; 91 (04) 636-641
    CrossrefPubMedGoogle Scholar
  • 37 Stanworth SJ, Hudson CL, Estcourt LJ, Johnson RJ, Wood EM. ; TOPPS study investigators. Risk of bleeding and use of platelet transfusions in patients with hematologic malignancies: recurrent event analysis. Haematologica 2015; 100 (06) 740-747
    CrossrefPubMedGoogle Scholar
  • 38 Stanworth SJ, Estcourt LJ, Powter G. , et al. TOPPS Investigators. A no-prophylaxis platelet-transfusion strategy for hematologic cancers. N Engl J Med 2013; 368 (19) 1771-1780
    CrossrefPubMedGoogle Scholar
  • 39 Carson JL, Terrin ML, Noveck H. , et al; FOCUS Investigators. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011; 365 (26) 2453-2462
    CrossrefPubMedGoogle Scholar
  • 40 Carson JL, Strair R. Transfusion strategies in hematologic and nonhematologic disease. Hematology Am Soc Hematol Educ Program 2014; 2014 (01) 548-552
    CrossrefPubMedGoogle Scholar
  • 41 Kaifie A, Kirschner M, Wolf D. , et al. Study Alliance Leukemia (SAL). Bleeding, thrombosis, and anticoagulation in myeloproliferative neoplasms (MPN): analysis from the German SAL-MPN-registry. J Hematol Oncol 2016; 9: 18
    CrossrefPubMedGoogle Scholar
  • 42 Brenner B, Hoffman R, Balashov D, Shutluko E, Culić SD, Nizamoutdinova E. Control of bleeding caused by thrombocytopenia associated with hematologic malignancy: an audit of the clinical use of recombinant activated factor VII. Clin Appl Thromb Hemost 2005; 11 (04) 401-410
    CrossrefPubMedGoogle Scholar
  • 43 McMahon B, Stein BL. Thrombotic and bleeding complications in classical myeloproliferative neoplasms. Semin Thromb Hemost 2013; 39 (01) 101-111
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 44 Ku GH, White RH, Chew HK, Harvey DJ, Zhou H, Wun T. Venous thromboembolism in patients with acute leukemia: incidence, risk factors, and effect on survival. Blood 2009; 113 (17) 3911-3917
    CrossrefPubMedGoogle Scholar
  • 45 Imberti D, Bianchi C, Zambon A. , et al. Venous thromboembolism after major orthopaedic surgery: a population-based cohort study. Intern Emerg Med 2012; 7 (03) 243-249
    CrossrefPubMedGoogle Scholar
  • 46 Falanga A, Marchetti M, Russo L. Venous thromboembolism in the hematologic malignancies. Curr Opin Oncol 2012; 24 (06) 702-710
    CrossrefPubMedGoogle Scholar
  • 47 Ong PH, Pua YH. A prediction model for length of stay after total and unicompartmental knee replacement. Bone Joint J 2013; 95-B (11) 1490-1496
    CrossrefPubMedGoogle Scholar
  • 48 Pugely AJ, Martin CT, Gao Y, Belatti DA, Callaghan JJ. Comorbidities in patients undergoing total knee arthroplasty: do they influence hospital costs and length of stay?. Clin Orthop Relat Res 2014; 472 (12) 3943-3950
    CrossrefPubMedGoogle Scholar
  • 49 Karam JA, Huang RC, Abraham JA, Parvizi J. Total joint arthroplasty in cancer patients. J Arthroplasty 2015; 30 (05) 758-761
    CrossrefPubMedGoogle Scholar
  • 50 Kuderer NM, Dale DC, Crawford J, Cosler LE, Lyman GH. Mortality, morbidity, and cost associated with febrile neutropenia in adult cancer patients. Cancer 2006; 106 (10) 2258-2266
    CrossrefPubMedGoogle Scholar
  • 51 Guler A, Sahin MA, Cingoz F, Ozal E, Demirkilic U, Arslan M. Can cardiac surgery be performed safely on patients with haematological malignancies. Cardiovasc J Afr 2012; 23 (04) 194-196
    CrossrefPubMedGoogle Scholar
  • 52 Karimova EJ, Rai SN, Wu J, Britton L, Kaste SC, Neel MD. Femoral resurfacing in young patients with hematologic cancer and osteonecrosis. Clin Orthop Relat Res 2008; 466 (12) 3044-3050
    CrossrefPubMedGoogle Scholar