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  • Title: Spondyloarthritis is associated with higher healthcare utilization and complication rates after primary total knee or total hip arthroplasty.
    Author: Singh JA, Cleveland JD.
    Journal: Clin Rheumatol; 2020 Aug; 39(8):2345-2353. PubMed ID: 32172464.
    Abstract:
    Our objective was to assess healthcare utilization and complication rates after primary total knee/hip arthroplasty (TKA/THA) in people with spondyloarthritis (SpA) compared with people without SpA. We performed multivariable-adjusted logistic regression using the 1998-2014 US National Inpatient Sample (NIS), adjusted for age, race/ethnicity, gender, income, Deyo-Charlson comorbidity index, insurance payer, and the underlying diagnosis. The primary THA cohort consisted of 4,116,484 THAs (1.7% with SpA) and primary TKA cohort of 8,127,282 TKAs (1% with SpA). Compared with people without SpA, people with SpA had higher odds ratio (OR (95% confidence interval (CI)) of the following post-THA and post-TKA, respectively: (1) discharge to care facility, 1.16 (1.12, 1.21) and 1.14 (1.11, 1.18); (2) hospital stay > 3 days, 1.15 (1.11, 1.20) and 1.05 (1.01, 1.10); and (3) transfusion, 1.16 (1.12, 1.21) and 1.10 (1.05, 1.14); but lower odds of (1) mortality, 0.78 (0.64, 0.96) and 0.40 (0.19, 0.84); and (2) hospital charges above the median, 0.49 (0.46, 0.53) and 0.48 (0.45, 0.51). SpA was associated with higher odds of implant infection, 3.02 (2.27, 4.03) post-TKA, not post-THA. In-hospital revision rate did not differ. People with SpA utilize more healthcare services and have more complications post-THA/TKA. Interventions to reduce complications and associated utilization are needed. Key Points • People with spondyloarthritis utilized more healthcare services and had a higher risk of transfusion post-THA/TKA, compared with people without spondyloarthritis. • Spondyloarthritis was associated with lower in-hospital mortality rates after THA/TKA. • Spondyloarthritis was associated with a higher risk of implant infection after TKA, but not THA. • A pre-operative discussion with people with spondyloarthritis of possibly higher implant infection after TKA could lead to a more informed consent.
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