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Abstract Number: 1908

Male Sex, Medical Comorbidity and Post-procedure Complications Are Associated with Higher In-hospital Mortality After Primary Total Knee Arthroplasty for Osteoarthritis

Sumanth Chandrupatla1, Kranti Rumalla2 and Jasvinder Singh3, 1University of Alabama at Birmingham, Birmingham, AL, 2Northwestern University Feinberg School of Medicine, Chicago, IL, 3Baylor College of Medicine, Birmingham, AL

Meeting: ACR Convergence 2024

Keywords: Arthroplasty, Disparities, Epidemiology, Health Services Research, Mortality

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Session Information

Date: Monday, November 18, 2024

Title: Healthcare Disparities in Rheumatology Poster III

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: We aimed to assess whether sex, comorbidity and postoperative complications are associated with in-patient mortality after primary total knee arthroplasty (TKA) for osteoarthritis (OA).

Methods: We used the 2016-2019 U.S. National Inpatient Sample (NIS), a nationally representative dataset.  We calculated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association of sex with in-hospital mortality after elective primary TKA for OA, adjusting for age, race/ethnicity, comorbidity, income, insurance payer, elective admission status, hospital characteristics (bed size, location/teaching status, region, control), and post-procedural complications (separated into implant-specific and medical complications).

Results: We studied 2,627,960 primary TKA hospitalizations for OA from the 2016-2019 NIS. Females were more likely to be non-White, have lower Deyo-Charlson Comorbidity Index, more likely to have Medicare or Medicaid payer, and have post-procedure complications (p< 0.001 each). Other statistically significant differences in income and hospital characteristics (hospital bed size, location/teaching status, region, control) were small in magnitude (p< 0.001 each).In multivariable-adjusted analysis, we found that female sex was associated with a significantly lower in-hospital mortality, aOR was 0.63 (95% CI, 0.43 – 0.93; p=0.02) (Table 1). We also found that in-hospital mortality was significantly lower in subjects in the two highest quartiles of household income, and for hospitals located in the Midwest (p< 0.05 each). In-hospital mortality was significantly higher in people with Deyo-Charlson comorbidity index score of one or two or more, and both implant-specific and medical post-procedure complications, respective aORs were 4.30 (95% CI, 2.36-7.81; p< 0.001), 11.06 (95% CI, 6.24-19.62; p< 0.001), 7.70 (95% CI, 1.05-56.60; p=0.04), and 12.91 (95% CI, 8.13-20.50; p< 0.001). The final full multivariable-adjusted model that included post-procedural complications had a ROC curve area of 0.85 (95% CI, 0.81 to 0.89).

Conclusion: In a large in the U.S. national representative cohort of primary TKA for OA, male sex, medical comorbidity and post-procedure complications were associated with a significantly higher in-hospital mortality. Further studies into whether comorbidity-specific peri-operative management could be potential target to reduce mortality and complications are needed.

Supporting image 1

Table 1: Multivariable-adjusted predictors of in-hospital mortality for patients with primary diagnosis of osteoarthritis hospitalized for all total knee arthroplasty total knee arthroplasty (TKA) in the U.S. National Inpatient Sample (N = 2,485,439) (2016_2019)

Supporting image 2

Figure 1: ROC curve for in-hospital mortality after primary total knee arthroplasty (TKA) in the U.S. National Inpatient Sample (N = 2,485,439) (2016_2019)


Disclosures: S. Chandrupatla: None; K. Rumalla: None; J. Singh: Adaptimmune Therapeutics, 2, Adept Field Solutions, 2, Aebona Pharmaceuticals, 11, Amarin, Viking and Moderna pharmaceuticals, 11, Atai life sciences, Kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, Ad, 11, Charlotte's Web Holdings, 11, Clinical Care options, 2, Enzolytics Inc, 11, Fidia, 2, Focus forward, 2, GeoVax Labs, 11, Intuitive Surgical Inc./Philips Electronics North America, 12, food and beverage payments, Jupiter Life Science, 2, MedIQ, 2, Medscape, 2, Medusas, 2, Navigant consulting, 2, Pieris Pharmaceuticals, 11, PK Med, 2, Practice Point communications, 2, Putnam associates, 2, ROMTech, Atheneum, Clearview healthcare partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals/DINORA, Frictionless Solution, 2, Schipher, 2, Seres Therapeutics, 11, speaker’s bureau of Simply Speaking, 6, Tonix Parmaceuticals, 11, Trio Health, 2, Two Labs Inc, 2, UBM LLC, 2, WebMD, 2, Zimmer Biomet Holdings, 5.

To cite this abstract in AMA style:

Chandrupatla S, Rumalla K, Singh J. Male Sex, Medical Comorbidity and Post-procedure Complications Are Associated with Higher In-hospital Mortality After Primary Total Knee Arthroplasty for Osteoarthritis [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/male-sex-medical-comorbidity-and-post-procedure-complications-are-associated-with-higher-in-hospital-mortality-after-primary-total-knee-arthroplasty-for-osteoarthritis/. Accessed .
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All abstracts accepted to ACR Convergence are under media embargo once the ACR has notified presenters of their abstract’s acceptance. They may be presented at other meetings or published as manuscripts after this time but should not be discussed in non-scholarly venues or outlets. The following embargo policies are strictly enforced by the ACR.

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