Sickle cell disease and readmissions rates after lower extremity arthroplasty: a multistate analysis 2007–2014
Abstract
Aim: To compare readmission rates between patients with sickle cell disease (SCD) and non-sickle cell disease undergoing total hip and knee arthroplasty (THA and TKA). Methods: Identified adult patients who underwent THA or TKA from 2007 to 2014 in California, Florida, New York, Maryland and Kentucky using a multistate database. Outcomes were 30- and 90-day readmission rates, mortality, complications, length of stay and hospital charges. Logistic regression models were used for analysis. Results: Compared with non-sickle cell disease patients following TKA and THA, SCD patients had higher odds of 30- (odds ratio [OR]: 3.79) and 90-day readmissions (OR: 4.15), mortality (OR: 6.54), more complications, longer length of stay, and higher total charges. Conclusion: Following TKA and THA, SCD is associated with higher readmissions and worse outcomes.
Supplementary Material
File (suppl_file.docx)
- Download
- 25.56 KB
References
1.
Kato GJ, Piel FB, Reid CD et al. Sickle cell disease. Nat. Rev. Dis. Primers 4, 18010 (2018).
2.
Ojodu J, Hulihan MM, Pope SN, Grant AM. Centers for Disease Control and Prevention (CDC). Incidence of sickle cell trait – United States, 2010. MMWR Morb. Mortal. Wkly. Rep. 63(49), 1155–1158 (2014).
3.
Niebuhr DW, Chen L, Shao S, Goldsmith J, Byrne C, Singer DE. Sickle cell trait prevalence among U.S. military service members: 1992–2012. Mil. Med. 182(3), e1819–e1824 (2017).
4.
Mvundura M, Amendah D, Kavanagh PL, Sprinz PG, Grosse SD. Health care utilization and expenditures for privately and publicly insured children with sickle cell disease in the United States. Pediatr. Blood Cancer 53(4), 642–646 (2009).
5.
Amendah DD, Mvundura M, Kavanagh PL, Sprinz PG, Grosse SD. Sickle cell disease-related pediatric medical expenditures in the U.S. Am. J. Prev. Med. 38(4 Suppl.), S550–S556 (2010).
6.
Adesina O, Brunson A, Keegan THM, Wun T. Osteonecrosis of the femoral head in sickle cell disease: prevalence, comorbidities, and surgical outcomes in California. Blood Adv. 1(16), 1287–1295 (2017).
7.
Mont MA, Marker DR, Zywiel MG, Carrino JA. Osteonecrosis of the knee and related conditions. J. Am. Acad. Orthop. Surg. 19(8), 482–494 (2011).
8.
Dinan MA, Chou CH, Hammill BG et al. Outcomes of inpatients with and without sickle cell disease after high-volume surgical procedures. Am. J. Hematol. 84(11), 703–709 (2009).
9.
Enayatollahi MA, Novack TA, Maltenfort MG, Tabatabaee RM, Chen AF, Parvizi J. In-hospital morbidity and mortality following total joint arthroplasty in patients with hemoglobinopathies. J. Arthroplasty 30(8), 1308–1312 (2015).
10.
Jiang HJ, Weiss AJ, Barrett ML et al. Characteristics of hospital stays for super-utilizers by payer, 2012: statistical brief #190. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality, MD, USA. (2006), www.ncbi.nlm.nih.gov/books/NBK310271/.
11.
Perfetti DC, Boylan MR, Naziri Q, Khanuja HS, Urban WP. Does sickle cell disease increase risk of adverse outcomes following total hip and knee arthroplasty? A nationwide database study. J. Arthroplasty 30(4), 547–551 (2015).
12.
Arroyo NS, White RS, Gaber-Baylis LK, La M, Fisher AD, Samaru M. Racial/ethnic and socioeconomic disparities in total knee arthroplasty 30- and 90-day readmissions: a multi-payer and multistate analysis, 2007–2014. Popul. Health Manag. (2018) (Epub ahead of print).
13.
White RS, Sastow DL, Gaber-Baylis LK, Tangel V, Fisher AD, Turnbull ZA. Readmission rates and diagnoses following total hip replacement in relation to insurance payer status, race and ethnicity, and income status. J. Racial Ethn. Health Disparities 5(6), 1202–1214 (2018).
14.
Steiner C, Elixhauser A, Schnaier J. The healthcare cost and utilization project: an overview. Eff. Clin. Pract. 5(3), 143–151 (2002).
15.
Overview of the State Inpatient Databases (SID). (2018) www.hcup-us.ahrq.gov/sidoverview.jsp#about.
16.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med. Care 36(1), 8–27 (1998).
17.
Quan H, Sundararajan V, Halfon P et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med. Care 43(11), 1130–1139 (2005).
18.
Requirements for Publishing Results with HCUP Data. (2018) www.hcup-us.ahrq.gov/db/publishing.jsp.
19.
Xu HF, White RS, Sastow DL, Andreae MH, Gaber-Baylis LK, Turnbull ZA. Medicaid insurance as primary payer predicts increased mortality after total hip replacement in the state inpatient databases of California, Florida and New York. J. Clin. Anesth. 43, 24–32 (2017).
20.
Lin DY, Psaty BM, Kronmal RA. Assessing the sensitivity of regression results to unmeasured confounders in observational studies. Biometrics 54(3), 948–963 (1998).
21.
Kamble S, Telen MJ, Dinan MA, Grussemeyer CA, Reed SD. Costs and length of stay for patients with and without sickle cell disease after hysterectomy, appendectomy, or knee replacement. Am. J. Hematol. 85(1), 79–81 (2010).
22.
Hernigou P, Zilber S, Filippini P, Mathieu G, Poignard A, Galacteros F. Total THA in adult osteonecrosis related to sickle cell disease. Clin. Orthop. Relat. Res. 466(2), 300–308 (2008).
23.
Centers for Medicare and Medicaid Services (CMS), HHS. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule. Fed. Regist. 77(170), 53257–53750 (2012).
24.
Centers for Medicare and Medicaid Services (CMS), HHS. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules. Fed. Regist. 78(160), 50495–51040 (2013).
25.
The Patient Protection and Affordable Care Act. DC, USA. www.healthcare.gov/where-can-i-read-the-affordable-care-act/.
26.
Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch. Intern. Med. 160(8), 1074–1081 (2000).
27.
O'Meara M, Davies G. Anaesthesia for patients with sickle cell disease (and other haemoglobinopathies). Anaesth. Intensive Care Med. 14(2), 54–56 (2013).
28.
Firth PG, Head CA. Sickle cell disease and anesthesia. Anesthesiology 101(3), 766–785 (2004).
29.
Khurmi N, Gorlin A, Misra L. Perioperative considerations for patients with sickle cell disease: a narrative review. Can. J. Anaesth. 64(8), 860–869 (2017).
30.
Bean CJ, Hooper WC, Ellingsen D, DeBaun MR, Sonderman J, Blot WJ. Discordance between self-report and genetic confirmation of sickle cell disease status in African–American adults. Public Health Genomics 17(3), 169–172 (2014).
31.
Brousseau DC, Owens PL, Mosso AL, Panepinto JA, Steiner CA. Acute care utilization and rehospitalizations for sickle cell disease. JAMA 303(13), 1288–1294 (2010).
32.
Panepinto JA, Brousseau DC, Hillery CA, Scott JP. Variation in hospitalizations and hospital length of stay in children with vaso-occlusive crises in sickle cell disease. Pediatr. Blood Cancer 44(2), 182–186 (2005).
33.
Steiner CA, Miller JL. Sickle cell disease patients in US hospitals, 2004: statistical brief #21. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Agency for Healthcare Research and Quality(US), MD, USA. (2006) Available from: www.ncbi.nlm.nih.gov/books/NBK63489/.
34.
Ilyas I, Alrumaih HA, Rabbani S. Noncemented total hip arthroplasty in sickle-cell disease: long-term results. J. Arthroplasty 33(2), 477–481 (2018).
35.
Kamble S, Telen MJ, Dinan MA, Grussemeyer CA, Reed SD. Costs and length of stay for patients with and without sickle cell disease after hysterectomy, appendectomy, or knee replacement. Am. J. Hematol. 85(1), 79–81 (2010).
36.
Hernigou P, Zilber S, Filippini P, Mathieu G, Poignard A, Galacteros F. Total THA in adult osteonecrosis related to sickle cell disease. Clin. Orthop. Relat. Res. 466(2), 300–308 (2008).
37.
Kalacy A, Ozkan C, Togrul E. Revision hip arthroplasty in sickle cell disease. Ann. Saudi Med. 27(2), 112–117 (2007).
38.
Lau MW, Blinder MA, Williams K, Galatz LM. Shoulder arthroplasty in sickle cell patients with humeral head avascular necrosis. J. Shoulder Elbow Surg. 16(2), 129–134 (2007).
39.
Al-Mousawi F, Malki A, Al-Aradi A, Al-Bagali M, Al-Sadadi A, Booz MM. Total hip replacement in sickle cell disease. Int. Orthop. 26(3), 157–161 (2002).
40.
Moran MC, Huo MH, Garvin KL, Pellicci PM, Salvati EA. Total hip arthroplasty in sickle cell hemoglobinopathy. Clin. Orthop. Relat. Res. 294, 140–148 (1993).
41.
Acurio MT, Friedman RJ. Hip arthroplasty in patients with sickle-cell haemoglobinopathy. J. Bone Joint Surg. Br. 74(3), 367–371 (1992).
42.
Clarke HJ, Jinnah RH, Brooker AF, Michaelson JD. Total replacement of the hip for avascular necrosis in sickle cell disease. J. Bone Joint Surg. Br. 71(3), 465–470 (1989).
43.
Bishop AR, Roberson JR, Eckman JR, Fleming LL. Total hip arthroplasty in patients who have sickle-cell hemoglobinopathy. J. Bone Joint Surg. Am. 70(6), 853–855 (1988).
44.
Adam S, Jonassaint J, Kruger H et al. Surgical and obstetric outcomes in adults with sickle cell disease. Am. J. Med. 121(10), 916–921 (2008).
45.
Ilyas I, Moreau P. Simultaneous bilateral total hip arthroplasty in sickle cell disease. J. Arthroplasty 17(4), 441–445 (2002).
46.
Vichinsky EP, Neumayr LD, Haberkern C et al. The perioperative complication rate of orthopedic surgery in sickle cell disease: report of the National Sickle Cell Surgery Study Group. Am. J. Hematol. 62(3), 129–138 (1999).
47.
Sanjay BK, Moreau PG. Bipolar hip replacement in sickle cell disease. Int. Orthop. 20(4), 222–226 (1996).
Information & Authors
Information
Published In
Copyright
© 2019 Future Medicine Ltd.
History
Received: 26 September 2018
Accepted: 14 January 2019
Published online: 20 March 2019
Keywords:
Topics
Authors
Metrics & Citations
Metrics
Article Usage
Article usage data only available from February 2023. Historical article usage data, showing the number of article downloads, is available upon request.
Citations
How to Cite
Sickle cell disease and readmissions rates after lower extremity arthroplasty: a multistate analysis 2007–2014. (2019) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2018-0098
Export citation
Select the citation format you wish to export for this article or chapter.
Citing Literature
- Akshay Khanna, Jad J. Lawand, Akin A. Adio, Alejandro M. Holle, Stephanie Eble, Joseph A. Abboud, Elevated risk of medical complications in sickle cell disease patients after total shoulder arthroplasty, Journal of Shoulder and Elbow Surgery, 10.1016/j.jse.2026.04.062, (2026).
- Hailey Ninness, Jarrod Woodland, John W. Moore, Brandon L. Rogalski, Richard J. Friedman, Sickle cell disease independently predicts increased 180-day complication rates and transfusions following primary total shoulder arthroplasty, Seminars in Arthroplasty: JSES, 10.1053/j.sart.2025.07.006, 36, 1, (151489), (2026).
- Francesca Simeone, Ayesha Abdeen, Surgical risk assessment, Evaluation and Management of Hip and Knee Arthritis in Women, 10.1016/B978-0-443-10559-3.00018-4, (75-84), (2026).
- Fareed F. Alfaya, Ramy Mohamed Ghazy, Esraa Abdellatif Hammouda, Ahmed A. Mahfouz, Hamad Khalid Faya, Mohammed Abdulrahman M Asiri, Osama Hasan M. Alalmaie, Naif Yahya Alshahrani, Ali Zafer A Alqahtani, Abdulaziz Y. Alshahrani, Shaimaa Abdelaziz Abdelmoneim, Total Hip Arthroplasty Complications in Sickle Cell Disease: Systematic Review and Meta-Analysis, Journal of Clinical Medicine, 10.3390/jcm13144129, 13, 14, (4129), (2024).
- Oluwasegun Aremu, Aanuoluwapo Adedokun, Toluwani Maxwell, Terver Mata, Is cost of surgery and hospital length of stay increased for sickle cell disease patients undergoing total joint replacement surgeries? Systematic review and multivariate meta-analysis, Journal of Orthopaedics, 10.1016/j.jor.2023.12.002, 50, (116-121), (2024).
- Philip M. Parel, Emile-Victor Kuyl, Amil R. Agarwal, Jordan S. Cohen, Alex Gu, Andrew B. Harris, Rachel A. Ranson, Savyasachi C. Thakkar, Gregory J. Golladay, 10-Year Cumulative Incidence and Indications for Revision Total Knee Arthroplasty Among Patients Who Have Sickle Cell Disease, The Journal of Arthroplasty, 10.1016/j.arth.2023.03.070, 38, 9, (1748-1753.e1), (2023).
- Emre Tokgoz, Sarah Levitt, Diana Sosa, Nicholas A. Carola, Vishal Patel, Emre Tokgoz, Sarah Levitt, Diana Sosa, Nicholas A. Carola, Vishal Patel, Preexisting Conditions Leading to Total Knee Arthroplasty, Total Knee Arthroplasty, 10.1007/978-3-031-31100-0_2, (19-36), (2023).
- Vibhu Krishnan Viswanathan, Sruthi Priyavadhana Ramanan, Jack Beale, Surabhi Subramanian, Varatharaj Mounasamy, Senthil Sambandam, How does sickle cell disease affect the peri-operative outcome in patients undergoing total knee arthroplasty? A large-scale, National Inpatient Sample-based study, Archives of Orthopaedic and Trauma Surgery, 10.1007/s00402-022-04762-1, 143, 8, (5261-5268), (2023).
- Tamara Huff, David Gibson, Mary I. O'Connor, Movement Is Life—Optimizing Patient Access to Total Joint Arthroplasty: Anemia and Sickle Cell Disease Disparities, Journal of the American Academy of Orthopaedic Surgeons, 10.5435/JAAOS-D-21-00911, 30, 22, (1059-1063), (2022).
- Alex Gu, Amil R Agarwal, Safa C Fassihi, Tom G Pollard, William T Stoll, Joshua C Campbell, Gregory J Golladay, Savyasachi C Thakkar, Impact of sickle cell disease on postoperative outcomes following total hip arthroplasty, HIP International, 10.1177/11207000211052224, 33, 3, (391-396), (2021).