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

Daniel J. Snyder, Dennis M. Bienstock, Aakash Keswani, Jared C. Tishelman, Amy Ahn, Ilda B. Molloy, Karl Koenig, David S. Jevsevar, Jashvant Poeran, Calin S. Moucha

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)839-845
Number of pages7
JournalJournal of Arthroplasty
Volume34
Issue number5
DOIs
StatePublished - May 1 2019

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Costs and Cost Analysis
Arthroplasty
Joints
Hip Injuries
High-Volume Hospitals
Patient Reported Outcome Measures
Knee Injuries
Hip Osteoarthritis
Knee Osteoarthritis
Veterans
Medicare
Health Surveys
Vascular Diseases
Anemia
Multivariate Analysis
Regression Analysis
Population

Keywords

  • HOOS
  • KOOS
  • VR-12
  • arthroplasty
  • episode-based outcomes
  • joint replacement
  • patient-reported outcomes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Snyder, D. J., Bienstock, D. M., Keswani, A., Tishelman, J. C., Ahn, A., Molloy, I. B., ... Moucha, C. S. (2019). Preoperative Patient-Reported Outcomes and Clinical Characteristics as Predictors of 90-Day Cost/Utilization and Complications. Journal of Arthroplasty, 34(5), 839-845. https://doi.org/10.1016/j.arth.2019.01.059

Preoperative Patient-Reported Outcomes and Clinical Characteristics as Predictors of 90-Day Cost/Utilization and Complications. / Snyder, Daniel J.; Bienstock, Dennis M.; Keswani, Aakash; Tishelman, Jared C.; Ahn, Amy; Molloy, Ilda B.; Koenig, Karl; Jevsevar, David S.; Poeran, Jashvant; Moucha, Calin S.

In: Journal of Arthroplasty, Vol. 34, No. 5, 01.05.2019, p. 839-845.

Research output: Contribution to journalArticle

Snyder, DJ, Bienstock, DM, Keswani, A, Tishelman, JC, Ahn, A, Molloy, IB, Koenig, K, Jevsevar, DS, Poeran, J & Moucha, CS 2019, 'Preoperative Patient-Reported Outcomes and Clinical Characteristics as Predictors of 90-Day Cost/Utilization and Complications', Journal of Arthroplasty, vol. 34, no. 5, pp. 839-845. https://doi.org/10.1016/j.arth.2019.01.059
Snyder, Daniel J. ; Bienstock, Dennis M. ; Keswani, Aakash ; Tishelman, Jared C. ; Ahn, Amy ; Molloy, Ilda B. ; Koenig, Karl ; Jevsevar, David S. ; Poeran, Jashvant ; Moucha, Calin S. / Preoperative Patient-Reported Outcomes and Clinical Characteristics as Predictors of 90-Day Cost/Utilization and Complications. In: Journal of Arthroplasty. 2019 ; Vol. 34, No. 5. pp. 839-845.
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abstract = "Background: 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. Methods: 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. Results: 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. Conclusion: 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.",
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AU - Bienstock, Dennis M.

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AU - Tishelman, Jared C.

AU - Ahn, Amy

AU - Molloy, Ilda B.

AU - Koenig, Karl

AU - Jevsevar, David S.

AU - Poeran, Jashvant

AU - Moucha, Calin S.

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N2 - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

AB - Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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