Preoperative Patient-Reported Outcomes and Clinical Characteristics as Predictors of 90-Day Cost/Utilization and Complications

• Published in: The Journal of arthroplasty Vol. 34; no. 5; pp. 839 - 845
• Main Authors: Snyder, Daniel J., Bienstock, Dennis M., Keswani, Aakash, Tishelman, Jared C., Ahn, Amy, Molloy, Ilda B., Koenig, Karl M., Jevsevar, David S., Poeran, Jashvant, Moucha, Calin S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019
• Subjects: Aged; Aged, 80 and over; arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - economics; Costs and Cost Analysis; episode-based outcomes; Female; HOOS; Humans; joint replacement; Knee Joint - surgery; KOOS; Male; Medicare; Middle Aged; Osteoarthritis, Knee - surgery; Patient Care Bundles - economics; Patient Discharge; Patient Reported Outcome Measures; patient-reported outcomes; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Retrospective Studies; Skilled Nursing Facilities; United States; VR-12; United States; patient-reported outcomes; VR-12; arthroplasty; episode-based outcomes; HOOS; KOOS; joint replacement
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2019.01.059

With the advent of mandatory bundle payments for total joint arthroplasty (TJA), assessing patients’ risk for increased 90-day complications and resource utilization is crucial. This study assesses the degree to which preoperative patient-reported outcomes predict 90-day complications, episode costs, and utilization in TJA patients. All TJA cases in 2017 at 2 high-volume hospitals were queried. Preoperative HOOS/KOOS JR (Hip Injury and Osteoarthritis Outcome Score/Knee Injury and Osteoarthritis Outcome Score) and Veterans RAND 12-item health survey (VR-12) were administered to patients preoperatively via e-collection platform. For patients enrolled in the Medicare bundle, cost data were extracted from claims. Bivariate and multivariate regression analyses were performed. In total, 2108 patients underwent TJA in 2017; 1182 (56%) were missing patient-reported outcome data and were excluded. The final study population included 926 patients, 199 (21%) of which had available cost data. Patients with high bundle costs tended to be older, suffer from vascular disease and anemia, and have higher Charlson scores (P < .05 for all). These patients also had lower baseline VR-12 Physical Component Summary Score (PCS; 24 vs 30, P ≤ .001) and higher rates of extended length of stay, skilled nursing facility discharge, 90-day complications, and 90-day readmission (P ≤ .04 for all). In multivariate analysis, higher baseline VR-12 PCS was protective against extended length of stay, skilled nursing facility discharge, >75th percentile bundle cost, and 90-day bundle cost exceeding target bundle price (P < .01 for all). Baseline VR-12 Mental Component Summary Score and HOOS/KOOS JR were not predictive of complications or bundle cost. Low baseline VR-12 PCS is predictive of high 90-day bundle costs. Baseline HOOS/KOOS JR scores were not predictive of utilization or cost. Neither VR-12 nor HOOS/KOOS JR was predictive of 90-day readmission or complications.