CORR Insights®: Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA
| Autor: | J. Wesley Mesko |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Reoperation Prosthesis-Related Infections Time Factors Databases Factual Knee Joint Medicare Patient Readmission Risk Assessment Health Services Accessibility 03 medical and health sciences 0302 clinical medicine Risk Factors Medicine Humans Orthopedics and Sports Medicine 030212 general & internal medicine Medicare Access and CHIP Reauthorization Act of 2015 Arthroplasty Replacement Knee Aged Retrospective Studies 030222 orthopedics Actuarial science business.industry General Medicine Health Care Costs Risk adjustment Middle Aged United States Models Economic Outcome and Process Assessment Health Care Surgery Female Risk Adjustment business Knee Prosthesis 2017 Musculoskeletal Infection Society Proceedings Value (mathematics) |
| Zdroj: | Clinical orthopaedics and related research. 476(10) |
| ISSN: | 1528-1132 |
| Popis: | BACKGROUND: The Medicare Access and CHIP Reauthorization Act of 2015 provides the framework to link reimbursement for providers based on outcome metrics. Concerns exist that the lack of risk adjustment for patients undergoing revision TKA for an infection may cause problems with access to care. QUESTIONS/PURPOSES: (1) After controlling for confounding variables, do patients undergoing revision TKA for infection have higher 30-day readmission, reoperation, and mortality rates than those undergoing revision TKA for aseptic causes? (2) Compared with patients undergoing revision TKA who are believed not to have infections, are patients undergoing revision for infected TKAs at increased risk for complications? METHODS: We queried the American College of Surgeons National Surgical Quality Improvement Program database for patients undergoing revision TKA from 2012 to 2015 identified by Current Procedural Terminology (CPT) codes 27486, 27487, and 27488. Of the 10,848 patients identified, four were excluded with a diagnosis of malignancy (International Classification of Diseases, 9th Revision code 170.7, 170.9, 171.8, or 198.5). This validated, national database records short-term outcome data for inpatient procedures and does not rely on administrative coding data. Demographic variables, comorbidities, and outcomes were compared between patients believed to have infected TKAs and those undergoing revision for aseptic causes. A multivariate logistic regression analysis was performed to identify independent factors associated with complications, readmissions, reoperations, and mortality. RESULTS: After controlling for demographic factors and medical comorbidities, TKA revision for infection was independently associated with complications (odds ratio [OR], 3.736; 95% confidence interval [CI], 3.198-4.365; p < 0.001), 30-day readmission (OR, 1.455; 95% CI, 1.207-1.755; p < 0.001), 30-day reoperation (OR, 1.614; 95% CI, 1.278-2.037; p < 0.001), and 30-day mortality (OR, 3.337; 95% CI, 1.213-9.180; p = 0.020). Patients with infected TKA had higher rates of postoperative infection (OR, 3.818; 95% CI, 3.082-4.728; p < 0.001), renal failure (OR, 36.709; 95% CI, 8.255-163.231; p < 0.001), sepsis (OR, 7.582; 95% CI, 5.529-10.397; p < 0.001), and septic shock (OR, 3.031; 95% CI, 1.376-6.675; p = 0.006). CONCLUSIONS: Policymakers should be aware of the higher rate of mortality, readmissions, reoperations, and complications in patients with infected TKA. Without appropriate risk adjustment or excluding these patients all together from alternative payment and quality reporting models, fewer providers will be incentivized to care for patients with infected TKA. LEVEL OF EVIDENCE: Level III, therapeutic study. |
| Databáze: | OpenAIRE |
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