J Knee Surg 2018; 31(06): 541-550
DOI: 10.1055/s-0037-1604442
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comparative Analysis of Hospital Length of Stay and Discharge Status of Two Contemporary Primary Total Knee Systems

Katherine Etter
1   Department of Medical Device – Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
,
Jason Lerner
2   Global Health Economics and Market Access, DePuy Synthes, Inc., Raynham, Massachusetts
,
Iftekhar Kalsekar
1   Department of Medical Device – Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
,
Carl de Moor
3   College of Health and Human Services, University of North Carolina at Charlotte, Charlotte, North Carolina
,
Andrew Yoo
1   Department of Medical Device – Epidemiology, Johnson & Johnson, New Brunswick, New Jersey
,
Michael Swank
4   Joint Preservation Restoration and Reconstruction Center, Christ Hospital, Cincinnati, Ohio
› Author Affiliations
Funding This study was funded by Johnson & Johnson.
Further Information

Publication History

27 October 2016

20 June 2017

Publication Date:
25 August 2017 (online)

Abstract

This study compares the differences in hospital length of stay (LOS), operating room time (ORT), discharge status, and total hospital costs among primary total knee arthroplasty (TKA) patients implanted with one of two contemporary primary total knee systems. A retrospective cohort analysis of elective inpatient, primary, unilateral TKA patients in the United States from 2013 to 2014 was conducted using the Premier Perspective® hospital billing database. The included patients had a diagnosis for osteoarthritis and received an ATTUNE® Knee (Gradually Reducing Radius Knee) or Triathlon™ (Single Radius Knee) from a hospital where both devices were used. Patient, provider, and procedure characteristics were included in generalized estimating equation (GEE) models to explore the impact of device on LOS, ORT, discharge status, and costs accounting for clustering within hospitals. A 1:1 propensity score–matched sensitivity analysis was also conducted. There were 1,178 patients who received gradually reducing radius knee and 5,707 patients who received single radius knee. GEE models indicated that the adjusted mean LOS and ORT for patients who received gradually reducing radius knee were significantly shorter than those who received single radius knee (p < 0.001). The adjusted odds ratios for gradually reducing radius knee patients being discharged to a skilled nursing facility (SNF) or other facility were 39% lower than that for single radius knee patients (odds ratio = 0.61; 95% confidence interval: 0.50–0.75; p < 0.001). The adjusted mean costs for gradually reducing radius knee patients were significantly lower than the single radius knee patients ($12,824 [1,813] vs. $18,713 [1,505]; p < 0.01). Findings were similar in the propensity-matched cohort of 2,044 patients, which was balanced on baseline covariates between devices (standardized differences were ≤ 8%). Patients who received gradually reducing radius knee had a shorter LOS and ORT, were less likely to be discharged to a SNF or other facility, and had lower total hospital cost than those who received single radius knee. These outcomes are increasingly relevant as hospitals bear the financial burden for episodes of care, and will require optimization to achieve success under the Centers for Medicare and Medicaid Services' Comprehensive Care for Joint Replacement model.

 
  • References

  • 1 Centers for Disease Control and Prevention (CDC). Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation--United States, 2010-2012. Morb Mortal Wkly Rep 2013; 62 (44) 869-873
  • 2 Hootman JM, Helmick CG, Barbour KE, Theis KA, Boring MA. Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults, 2015-2040. Arthritis Rheumatol 2016; 68 (07) 1582-1587
  • 3 Lee JK, Choi CH. Total knee arthroplasty in rheumatoid arthritis. Knee Surg Relat Res 2012; 24 (01) 1-6
  • 4 Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement. A meta-analysis. JAMA 1994; 271 (17) 1349-1357
  • 5 Skinner HB, Sekiya JK, Jameel O, McMahon PJ. Current Diagnosis & Treatment in Orthopedics. 5th ed. New York: McGraw-Hill Education; 2014
  • 6 Cram P, Lu X, Kates SL, Singh JA, Li Y, Wolf BR. Total knee arthroplasty volume, utilization, and outcomes among Medicare beneficiaries, 1991-2010. JAMA 2012; 308 (12) 1227-1236
  • 7 Stéphan F, Boucheseiche S, Hollande J. , et al. Pulmonary complications following lung resection: a comprehensive analysis of incidence and possible risk factors. Chest 2000; 118 (05) 1263-1270
  • 8 Synthes D. Attune® knee system. Value analysis brief. 2015 . Available at: http://synthes.vo.llnwd.net/o16/LLNWMB8/US%20Mobile/Synthes%20North%20America/Product%20Support%20Materials/Product%20Information%20Sheets/DSUS-JRC-0514-0188%20Val%20Brief.pdf . Accessed August 25, 2016
  • 9 Parvizi J, Mortazavi SM, Devulapalli C, Hozack WJ, Sharkey PF, Rothman RH. Secondary resurfacing of the patella after primary total knee arthroplasty does the anterior knee pain resolve?. J Arthroplasty 2012; 27 (01) 21-26
  • 10 Mahoney OM, McClung CD, dela Rosa MA, Schmalzried TP. The effect of total knee arthroplasty design on extensor mechanism function. J Arthroplasty 2002; 17 (04) 416-421
  • 11 Cook LE, Klika AK, Szubski CR, Rosneck J, Molloy R, Barsoum WK. Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty. J Knee Surg 2012; 25 (03) 249-253
  • 12 DePuy International. Survivorship of Attune Primary Total Knee Prosthesis. Available at: https://clinicaltrials.gov/ct2/show/NCT01754363 . NLM identifier: NCT01754363. Accessed September 15, 2016
  • 13 DePuy Orthopaedics. Prospective, Multiconfiguration Study to Assess Functional Performance of Primary Total Knee Arthroplasty System (10004). Available at: https://clinicaltrials.gov/ct2/show/NCT01746524 . NLM identifier: NCT01746524. Accessed September 15, 2016
  • 14 Cook JR, Warren M, Ganley KJ, Prefontaine P, Wylie JW. A comprehensive joint replacement program for total knee arthroplasty: a descriptive study. BMC Musculoskelet Disord 2008; 9: 154
  • 15 Ramos NL, Karia RJ, Hutzler LH, Brandt AM, Slover JD, Bosco JA. The effect of discharge disposition on 30-day readmission rates after total joint arthroplasty. J Arthroplasty 2014; 29 (04) 674-677
  • 16 Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty?. Acta Orthop 2011; 82 (06) 679-684
  • 17 London DA, Vilensky S, O'Rourke C, Schill M, Woicehovich L, Froimson MI. Discharge disposition after joint replacement and the potential for cost savings: effect of hospital policies and surgeons. J Arthroplasty 2016; 31 (04) 743-748
  • 18 Safavi KC, Dharmarajan K, Kim N. , et al. Variation exists in rates of admission to intensive care units for heart failure patients across hospitals in the United States. Circulation 2013; 127 (08) 923-929
  • 19 Yank V, Tuohy CV, Logan AC. , et al. Comparative Effectiveness of In-Hospital Use of Recombinant Factor VIIa for Off-Label Indications vs. Usual Care. Rockville, MD: Agency for Healthcare Research and Quality (US); 2010
  • 20 Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45 (06) 613-619
  • 21 Anglin C, Brimacombe JM, Hodgson AJ. , et al. Determinants of patellar tracking in total knee arthroplasty. Clin Biomech (Bristol, Avon) 2008; 23 (07) 900-910
  • 22 Schwarzkopf R, Ho J, Quinn JR, Snir N, Mukamel D. Factors influencing discharge destination after total knee arthroplasty: a database analysis. Geriatr Orthop Surg Rehabil 2016; 7 (02) 95-99
  • 23 Tian WA. An All-Payer View of Hospital Discharge to Postacute Care, 2013. HCUP Statistical Brief #205, 2016. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdf . Accessed September 20, 2016
  • 24 Winemaker M, Petruccelli D, Kabali C, de Beer J. Not all total joint replacement patients are created equal: preoperative factors and length of stay in hospital. Can J Surg 2015; 58 (03) 160-166
  • 25 Yasunaga H, Tsuchiya K, Matsuyama Y, Ohe K. Analysis of factors affecting operating time, postoperative complications, and length of stay for total knee arthroplasty: nationwide web-based survey. J Orthop Sci 2009; 14 (01) 10-16
  • 26 Bozic KJ, Ward L, Vail TP, Maze M. Bundled payments in total joint arthroplasty: targeting opportunities for quality improvement and cost reduction. Clin Orthop Relat Res 2014; 472 (01) 188-193
  • 27 Department of Health and Human Services. Centers for Medicare & Medicaid Services. 42 CFR Part 510. [CMS-5516-F], Medicare Program; Comprehensive Care for Joint Replacement Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement. Available at: www.gpo.gov/fdsys/pkg/FR-2015-11-24/pdf/2015-29438.pdf ; Accessed May 23, 2017