Risk Factors for Early Revision After Primary TKA in Medicare Patients

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• 作者：Kevin J. Bozic MD ; MBA (1) (2)
  Edmund Lau MS (3)
  Kevin Ong PhD (4)
  Vanessa Chan MPH (1) (2)
  Steven Kurtz PhD (4)
  Thomas P. Vail MD (1)
  Harry E. Rubash MD (5)
  Daniel J. Berry MD (6)
  
• 刊名：Clinical Orthopaedics and Related Research?
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：472
• 期：1
• 页码：232-237
• 全文大小：
• 作者单位：Kevin J. Bozic MD, MBA (1) (2)
  Edmund Lau MS (3)
  Kevin Ong PhD (4)
  Vanessa Chan MPH (1) (2)
  Steven Kurtz PhD (4)
  Thomas P. Vail MD (1)
  Harry E. Rubash MD (5)
  Daniel J. Berry MD (6)
  
  1. Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus MU 320W, San Francisco, CA, 94143-0728, USA
  2. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 500 Parnassus, MU 320W, San Francisco, CA, 94143-0728, USA
  3. Exponent, Inc, Menlo Park, CA, USA
  4. Exponent, Inc, Philadelphia, PA, USA
  5. Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, USA
  6. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
  
• ISSN：1528-1132

文摘

Background Patient, surgeon, health system, and device factors are all known to influence outcomes in total knee arthroplasty (TKA). However, patient-related factors associated with an increased risk of early failure are not well understood, particularly in elderly patients. Questions/purposes The purpose of this study was to identify specific comorbid conditions associated with increased risk of early revision in Medicare patients undergoing TKA. Methods A total of 117,903 Medicare patients who underwent primary TKA between 1998 and 2010 were identified from the Medicare 5% national sample administrative database and used to determine the relative risk of revision within 12 months after primary TKA as a function of baseline medical comorbidities. Cox regression was used to evaluate the impact of 29 comorbid conditions on risk of early failure controlling for age, sex, race, census region, socioeconomic status, and all other baseline comorbidities. Results The most significant independent risk factors for revision TKA within 12 months were chronic pulmonary disease, depression, alcohol abuse, drug abuse, renal disease, hemiplegia or paraplegia, and obesity. Conclusions This information could be valuable to patients and their surgeons when making shared medical decisions regarding elective TKA and for risk-stratifying publicly reported outcomes in Medicare patients undergoing TKA. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.