This article is more than 5 years old. Information may no longer be current.
Study: Transfusion risks, costs for TKA procedures vary with comorbidity burden
Patients with higher Charlson Comorbidity Index had greater odds for transfusion.
Click Here to Manage Email Alerts
Patients who had increased comorbidities or underwent simultaneous bilateral total knee arthroplasty or revision surgery had an increased risk for transfusion compared with healthy patients who underwent primary procedures, which correlated with higher hospitalization costs, according to study results.
“We did confirm that for bilateral procedures, there is a substantial increased risk of having a transfusion,” Christine I. Nichols, MA, MBA, of Medtronic Advanced Energy, told Orthopedics Today. “Specifically, bilateral knees were at higher risk for a transfusion procedure relative to bilateral total knee arthroplasty or revision procedures.”
Transfusion increases cost
Nichols and her colleague, Joshua G. Vose, MD, reviewed data between 2008 and 2014 from the Premier Perspective database for patients who underwent primary unilateral total knee arthroplasty (TKA), simultaneous bilateral TKA or revision TKA. Investigators assessed patient demographics, clinical characteristics, tranexamic acid use, length of stay and hospitalization.
Results showed transfusions were needed in 14.1% of patients who underwent unilateral TKA, in 36.3% of patients who underwent bilateral TKA and in 20% of patients who needed revision surgery. Logistic regression analyses showed risk factors for autologous and allogenic transfusion were patient age older than 65 years, female gender, care at a northeastern hospital in the United States, care at a large hospital, non-commercial payer type and increased Charlson Comorbidity Index (CCI) score.
“Not only did we look at the overall transfusion rate by knee procedures, [but] we also looked within each knee procedure [and asked], ‘Were patients at higher risk for having a transfusion based on how sick they were?’” Nichols said. “For [all primary, bilateral and revision] procedures, the sicker the patient, the greater the odds of having a transfusion.” Sickness was defined by CCI score.
According to researchers, the risk of transfusion declined during the study period. However, patients with a higher CCI still had greater odds for transfusion compared with healthy patients. Results from the generalized linear model showed incremental total hospitalization cost of a transfusion was highest among patients who underwent revision TKA followed by bilateral then primary procedures.
“We are interested in the impact of different patient characteristics on outcomes by total joint procedure, whether they are revisions, bilateral or primary unilateral procedures for total knee and total hip arthroplasty,” Vose said. “What you see in clinical practice is the care algorithm for patients are by and large the same, yet the outcomes are different, so that should imply you need to do something different either intraoperatively or perioperatively to get the same outcome as healthy patients.”
Follow-up study
To see the implication of transfusion long term, Vose and Nichols evaluated the association of factors and costs with discharge destination and readmission within 90 days.
“We broke out patients again by how sick they were upon admission and then looked at [what] we are calling the pathway of care,” Nichols said.
She continued, “What we saw again confirmed our hypothesis that the sicker the patient, the more the patient had a complication or a transfusion, the more the patient was discharged to more costly postacute care destinations, and that correlated with readmission risks. There were clear lines of high-cost patient pathways vs. the lowest cost pathway, and risk stratification is going to be important with implementation of Medicare’s [Comprehensive Care for Joint Replacement Model] CJR program and identifying early on who these patients are that are most at risk for pushing the hospital over their bundle.” – by Monica Jaramillo and Casey Tingle
- References:
- Nichols CI, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2015.10.013.
- Nichols CI, et al. J Arthroplasty. 2016;doi:10.1016/j.arth.2016.01.022.
- For more information:
- Christine I. Nichols, MA, MBA, can be reached at Medtronic Advanced Energy, 180 International Dr., Portsmouth, NH 03801; email: christine.nichols@medtronic.com.
- Joshua G. Vose, MD, can be reached at Medtronic Advanced Energy, 180 International Dr., Portsmouth, NH 03801; email: joshua.vose@medtronic.com.
Disclosures: Nichols and Vose report they are employed by Medtronic.