Not All Total Hip and Knee Arthroplasties Are The Same: What Are The Implications In Large Database Studies?

David E DeMik; Christopher N Carender; Natalie A Glass; Timothy S Brown; Jacob M Elkins; Nicholas A Bedard

doi:10.1016/j.arth.2022.02.119

Back

Not All Total Hip and Knee Arthroplasties Are The Same: What Are The Implications In Large Database Studies?

Journal article

Peer reviewed

Not All Total Hip and Knee Arthroplasties Are The Same: What Are The Implications In Large Database Studies?

David E DeMik, Christopher N Carender, Natalie A Glass, Timothy S Brown, Jacob M Elkins and Nicholas A Bedard

The Journal of arthroplasty, Vol.37(7), pp.1247-1252.e2

03/07/2022

DOI: 10.1016/j.arth.2022.02.119

PMID: 35271975

View Online

Abstract

Use of claims databases for research after total hip and knee arthroplasty (THA, TKA) has increased exponentially. These studies rely on accurate coding and inadvertent inclusion of patients with non-routine indications may influence results. The purpose of this study was to evaluate the complexity of THA and TKA captured by CPT code and determine if complication rates vary based on indication. The NSQIP database was queried using CPT codes 21730 and 27447 to identify patients undergoing THA and TKA from 2018-2019. Surgical indication was classified based on ICD-10 diagnosis code as: routine primary, complex primary, inflammatory, fracture, oncologic, revision, infection, or indeterminant. Patient factors and 30-day complications, readmission, reoperation, and wound complications were compared. 86,009 THA patients had 703 ICD-10 diagnosis codes and 91.4% were routine primary indications. Complication rates were: routine primary 7.4%, complex primary 11.3%, inflammatory 12.5%, fracture 23.9%, oncologic 32.4%, revision 26.9%, infection 38.7%, and indeterminant 10.3% (p<0.0001). 137,500 TKA patients had 552 ICD-10 diagnosis codes and 96.1% were routine primary cases. Complication rates were: routine primary 5.9%, complex primary 8.0%, inflammatory 7.2%, fracture 38.9%, oncologic 32.7%, revision 13.3%, infection 37.7%, and indeterminant 9.6% (p<0.0001). Routine primary arthroplasty had significantly lower rates of reoperation, readmission, and wound complications. Using CPT code alone captures 10% of THA and 4% of TKA patients with procedures for non-routine primary indications. It is essential to recognize identification of patients simply by CPT code has the potential to inadvertently introduce bias and surgeons should critically assess methods used to define the study populations.

Coding

Complications

Total Knee Arthroplasty

Indications

International Classifications of Diseases

Common Procedural Terminology

Total Hip Arthroplasty

Details

Title: Subtitle: Not All Total Hip and Knee Arthroplasties Are The Same: What Are The Implications In Large Database Studies?
Creators: David E DeMik - University of Iowa
Christopher N Carender - University of Iowa
Natalie A Glass - University of Iowa
Timothy S Brown - Houston Methodist
Jacob M Elkins - University of Iowa
Nicholas A Bedard - Mayo Clinic in Arizona
Resource Type: Journal article
Publication Details: The Journal of arthroplasty, Vol.37(7), pp.1247-1252.e2
DOI: 10.1016/j.arth.2022.02.119
PMID: 35271975
NLM abbreviation: J Arthroplasty
eISSN: 1532-8406
Language: English
Date published: 03/07/2022
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation
Record Identifier: 9984226810902771

Metrics

8 Record Views

1 Times Cited - Web of Science