ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2523

Region, Race, and Hospital Factors Impact Length of Stay and Hospital Charges Post-primary Total Knee Arthroplasty

Kranti Rumalla1, Sumanth Chandrupatla2 and Jasvinder Singh2, 1Northwestern School of Medicine, Chicago, IL, 2University of Alabama at Birmingham, Birmingham, AL

Meeting: ACR Convergence 2023

Keywords: , , ,

Session Information

Date: Tuesday, November 14, 2023

Title: Abstracts: Orthopedics, Low Back Pain, & Rehabilitation

Session Type: Abstract Session

Session Time: 4:00PM-5:30PM

Background/Purpose: Osteoarthritis (OA) affects nearly 33 million adults in the US and total knee arthroplasty (TKA) is an effective treatment. Outcomes can vary by regional and hospital level disparities. We sought to determine patient characteristics and hospital level factors of extended hospital stays and increased costs in patients with knee OA who underwent primary TKA in a nationally representative sample.

Methods: We examined patients from the 2019 National Inpatient Sample (NIS) with OA who underwent primary TKA using the International Classification of Disease 10th Edition (ICD-10) Diagnosis and Procedure codes. Patient and regional characteristics were assessed. Primary outcomes were extended length of stay (eLOS) and increased hospital charges (IHC), determined as the upper quartile of each outcome. Multivariable analysis determined independent predictors for each outcome. Area Under the Curve (AUC) analysis assessed classification ability.

Results: 543,291 patients underwent TKA in 2019; 61.7% were female and 81.3% were white. Independent predictors of IHC include hospital bed size (p < 0.001), location & teaching status (p < 0.001), and hospital control (p < 0.001). South and West region hospitals a significantly higher adjusted odds ratio (aOR 1.54 & 2.79, p < 0.001) of IHC when compared to Northeastern region hospitals. Significant independent predictors of eLOS include race & ethnicity (p < 0.001), payer (p < 0.001), and hospital control (p < 0.001). Multivariable models for eLOS and IHC had AUC C-statistic scores of 0.74 and 0.76, respectively, demonstrating a modest classification ability.

Conclusion: Patient race/ethnicity, payer, regional and hospital level characteristics impacted outcomes and costs for the OA patients who underwent primary TKA in 2019. A stronger emphasis to address regional, hospital-level, and racial disparities can improve outcomes for the thousands of OA patients who undergo TKA every year.

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Disclosures: K. Rumalla: None; S. Chandrupatla: None; J. Singh: Other, 2, 6, 11, 11, 12, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc., Seres Therapeutics, Tonix, Charlotte’s Web, 12, Atai life sciences, kintara therapeutics, Intelligent Biosolutions, Acumen pharmaceutical, TPT Global Tech, Vaxart pharmaceuticals, Atyu biopharma, 12, speaker’s bureau of Simply Speaking, other, 12, received institutional research support from Zimmer Biomet Holdings. JAS received food and beverage payments from Intuitive Surgical Inc./Philips Elec, Other, 12, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc., Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam.

To cite this abstract in AMA style:

Rumalla K, Chandrupatla S, Singh J. Region, Race, and Hospital Factors Impact Length of Stay and Hospital Charges Post-primary Total Knee Arthroplasty [abstract]. Arthritis Rheumatol. 2023; 75 (suppl 9). https://acrabstracts.org/abstract/region-race-and-hospital-factors-impact-length-of-stay-and-hospital-charges-post-primary-total-knee-arthroplasty/. Accessed .

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