Document Detail


Sex and surgical outcomes and mortality after primary total knee arthroplasty: a risk-adjusted analysis.
MedLine Citation:
PMID:  23335560     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Total knee arthroplasty (TKA) is a widely utilized and effective treatment option for end-stage knee osteoarthritis (OA). Knee OA is more prevalent among women compared to men, but there are limited data on the sex differences in surgical outcomes after primary TKA.
METHODS: Our sample consisted of all primary TKAs performed in Pennsylvania during the fiscal year 2002. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify major complications and surgical revision. We used mixed-effects logistic regression models to examine the associations between sex and all-cause mortality, readmissions, and major surgical complications. We used proportional hazards models to assess the risk of surgical revision after index arthroplasty. We adjusted for race, age, hospital teaching status, hospital procedure volume, insurance status, and risk of mortality.
RESULTS: In 17,994 primary TKAs, there were 46 and 220 deaths at 30 days and 1 year, respectively. Compared to women, men had higher adjusted odds of 1-year mortality (odds ratio [OR] 1.48 [95% confidence interval (95% CI) 1.13-1.94]) after primary TKA. The overall odds of most major 30-day complications did not differ by sex except for surgical wound infections, which were higher in men compared to women (OR 1.31 [95% CI 1.08-1.60]); 30-day readmission was higher in men (OR 1.25 [95% CI 1.10-1.43]). Men had significantly higher rates of revision of index knee arthroplasty at 5 years (hazard ratio 1.20 [95% CI 1.05-1.36]) compared to women.
CONCLUSION: The higher rates of mortality, hospital readmissions, revision surgery, and wound infections in men undergoing elective primary TKA compared to women indicate there is a sex disparity in these outcomes.
Authors:
Jasvinder A Singh; C Kent Kwoh; Diane Richardson; Wei Chen; Said A Ibrahim
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Arthritis care & research     Volume:  65     ISSN:  2151-4658     ISO Abbreviation:  Arthritis Care Res (Hoboken)     Publication Date:  2013 Jul 
Date Detail:
Created Date:  2013-07-02     Completed Date:  2013-09-05     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  101518086     Medline TA:  Arthritis Care Res (Hoboken)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1095-102     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 by the American College of Rheumatology.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arthroplasty, Replacement, Knee / adverse effects*,  mortality*
Chi-Square Distribution
Female
Hospitals, High-Volume
Hospitals, Low-Volume
Hospitals, Teaching
Humans
Insurance, Health
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Osteoarthritis, Knee / ethnology,  mortality,  surgery*
Patient Readmission
Pennsylvania / epidemiology
Postoperative Complications / mortality*,  surgery
Proportional Hazards Models
Reoperation
Risk Assessment
Risk Factors
Sex Factors
Surgical Procedures, Elective
Surgical Wound Infection / mortality,  surgery
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K24-AR-055259/AR/NIAMS NIH HHS; U01 AG018947/AG/NIA NIH HHS
Comments/Corrections

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