Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: A 13-year study of time trends

BMC Musculoskeletal Disorders

David G Lewallen¹  Jasvinder A Singh¹ 

[1] Department of Orthopedic Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

关键词: Osteoarthritis;    Comorbidity;    Obesity;    Diagnosis;    Joint replacement;    Arthroplasty;    Time trends;    Total hip replacement;   

Others  :  1090340
DOI  :  10.1186/1471-2474-15-441

 received in 2014-06-16, accepted in 2014-12-10,  发布年份 2014

【 摘 要 】

Background

Few, if any data are available are available regarding the time-trends in characteristics of patients who have undergone primary THA. Our objective was to examine the time-trends in key demographic and clinical characteristics of patients undergoing primary total hip arthroplasty (THA).

Methods

We used the data from the Mayo Clinic Total Joint Registry from 1993–2005 to examine the time-trends in demographics (age, body mass index (BMI)), medical (Deyo-Charlson index) and psychological comorbidity (anxiety, depression) and underlying diagnosis of patients undergoing primary THA. Chi-square test and analysis for variance were used. Multivariable-adjusted logistic regression (age, sex, comorbidity-adjusted) compared 1993–95 to other study periods. Odds ratio (OR) and 95% confidence interval (CI) are presented.

Results

The primary THA cohort consisted of 6,168 patients with 52% women. In unadjusted analyses, compared to 1993–95, significantly more patients (by >2-times for most) in 2002–05 had: BMI ≥ 40, 2.3% vs. 6.3%; depression, 4.1% vs. 9.8%; and anxiety, 3.4% vs. 5.7%; and significantly fewer had an underlying diagnosis of rheumatoid/inflammatory arthritis, 3.7% vs. 1.5% (p ≤ 0.01 for all). In multivariable-adjusted models, compared to 1993–95, significantly more patients in 2003–05 had (all p-values ≤ 0.01): BMI ≥ 40, OR, 2.79 (95% CI: 1.85, 4.22); Deyo-Charlson Index ≥ 3, 1.32 (1.07, 1.63); depression, 2.25 (1.66, 3.05); and anxiety, 1.71 (1.19, 2.15). Respectively, fewer patients had a diagnosis of RA/inflammatory arthritis: 0.28 (0.17, 0.46; p < 0.01). Over the 13-year study period, Deyo-Charlson index increased by 22% (0.9 to 1.1) and the mean age decreased by 0.7 years (65.0 to 64.3) (p < 0.01 for both).

Conclusions

Obesity, medical and psychological comorbidity increased and the underlying diagnosis of RA/inflammatory arthritis decreased rapidly in primary THA patients over 13-years. Our cohort characteristics are similar to previously described characteristics of national U.S. cohort, suggesting that these trends may be national rather than local trends. This is important information for policy makers to take into account for resource allocation. Studies of THA outcomes and utilization should take these rapidly changing patient characteristics into account.

【 授权许可】

   
2014 Singh and Lewallen; licensee BioMed Central.

【 参考文献 】

• [1]Learmonth ID, Young C, Rorabeck C: The operation of the century: total hip replacement. Lancet 2007, 370(9597):1508-1519. Epub 2007/10/30
• [2]HCUP: HCUP Facts and Figures 2009- Section 3: Inpatient Hospital Stays by Procedure. Exhibit 3.1 Most Frequent All-listed Procedures. http://hcup-us.ahrq.gov/reports/factsandfigures/2009/pdfs/FF_report_2009.pdf webcite
• [3]Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY: Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004, 86-A(5):963-974. Epub 2004/05/01
• [4]Healthcare Cost and Utilization Project (HCUP): HCUP Facts and Figures 2009- Section 3: Inpatient Hospital Stays by Procedure. Exhibit 3.1 Most Frequent All-listed Procedures. http://hcup-us.ahrq.gov/reports/factsandfigures/2009/pdfs/FF_report_2009.pdf webcite. Rockville, MD: Agency for Healthcare Research and Quality; 2012 [updated February 201202/10/2014]
• [5]Singh JA, Vessely MB, Harmsen WS, Schleck CD, Melton LJ 3rd, Kurland RL, Berry DJ: A population-based study of trends in the use of total hip and total knee arthroplasty, 1969–2008. Mayo Clin Proc 2010, 85(10):898-904. Epub 2010/09/09
• [6]Cram P, Lu X, Kaboli PJ, Vaughan-Sarrazin MS, Cai X, Wolf BR, Li Y: Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991–2008. JAMA 2011, 305(15):1560-1567. Epub 2011/04/21
• [7]Espehaug B, Furnes O, Engesaeter LB, Havelin LI: Hip arthroplasty in Norway 1989–2008. Tidsskr Nor Laegeforen 2011, 131(16):1543-1548.
• [8]Jimenez-Garcia R, Villanueva-Martinez M, Fernandez-de-Las-Penas C, Hernandez-Barrera V, Rios-Luna A, Garrido PC, de Andres AL, Jimenez-Trujillo I, Montero JS, Gil-de-Miguel A: Trends in primary total hip arthroplasty in Spain from 2001 to 2008: evaluating changes in demographics, comorbidity, incidence rates, length of stay, costs and mortality. BMC Musculoskelet Disord 2011, 12:43. Epub 2011/02/11 BioMed Central Full Text
• [9]Kirksey M, Chiu YL, Ma Y, Della Valle AG, Poultsides L, Gerner P, Memtsoudis SG: Trends in in-hospital major morbidity and mortality after total joint arthroplasty: United States 1998–2008. Anesth Analg 2012, 115(2):321-327.
• [10]Liu SS, Della Valle AG, Besculides MC, Gaber LK, Memtsoudis SG: Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States. Int Orthop 2009, 33(3):643-651. Epub 2008/05/08
• [11]Sheehan E, Neligan M, Murray P: Hip arthroplasty, changing trends in a national tertiary referral centre. Ir J Med Sci 2002, 171(1):13-15. Epub 2002/05/08
• [12]Huddleston JI, Wang Y, Uquillas C, Herndon JH, Maloney WJ: Age and obesity are risk factors for adverse events after total hip arthroplasty. Clin Orthop Relat Res 2012, 470(2):490-496. Epub 2011/07/29
• [13]Yeung E, Jackson M, Sexton S, Walter W, Zicat B, Walter W: The effect of obesity on the outcome of hip and knee arthroplasty. Int Orthop 2011, 35(6):929-934. Epub 2010/06/01
• [14]Singh JA, Lewallen D: Age, gender, obesity, and depression are associated with patient-related pain and function outcome after revision total hip arthroplasty. Clin Rheumatol 2009, 28(12):1419-1430. Epub 2009/09/04
• [15]Namba RS, Paxton L, Fithian DC, Stone ML: Obesity and perioperative morbidity in total hip and total knee arthroplasty patients. J Arthroplasty 2005, 20(7 Suppl 3):46-50. Epub 2005/10/11
• [16]Ma J, Xiao L, Stafford RS: Underdiagnosis of obesity in adults in US outpatient settings. Arch Intern Med 2009, 169(3):313-314. Epub 2009/02/11
• [17]Statistics related to overweight and obesity: Economic Costs Related to Overweight and Obesity, Weight-Control Information Network. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); 2006. 2013 [03/30/2014]
• [18]Riediger W, Doering S, Krismer M: Depression and somatisation influence the outcome of total hip replacement. Int Orthop 2010, 34(1):13-18. Epub 2008/11/27
• [19]Brull R, McCartney CJ, Chan VW: Do preoperative anxiety and depression affect quality of recovery and length of stay after hip or knee arthroplasty? Can J Anaesth 2002, 49(1):109. Epub 2002/01/10
• [20]Judge A, Arden NK, Cooper C, Kassim Javaid M, Carr AJ, Field RE, Dieppe PA: Predictors of outcomes of total knee replacement surgery. Rheumatology (Oxford) 2012, 51(10):1804-1813. Epub 2012/04/26
• [21]Baker PN, van der Meulen JH, Lewsey J, Gregg PJ: The role of pain and function in determining patient satisfaction after total knee replacement. Data from the National Joint Registry for England and Wales. J Bone Joint Surg (Br) 2007, 89(7):893-900. Epub 2007/08/04
• [22]Pun SY, Ries MD: Effect of gender and preoperative diagnosis on results of revision total knee arthroplasty. Clin Orthop Relat Res 2008, 466(11):2701-2705. Epub 2008/08/30
• [23]Kurtz SM, Lau E, Ong K, Zhao K, Kelly M, Bozic KJ: Future young patient demand for primary and revision joint replacement: national projections from 2010 to 2030. Clin Orthop Relat Res 2009, 467(10):2606-2612. Epub 2009/04/11
• [24]Khatod M, Inacio M, Paxton EW, Bini SA, Namba RS, Burchette RJ, Fithian DC: Knee replacement: epidemiology, outcomes, and trends in Southern California: 17,080 replacements from 1995 through 2004. Acta Orthop 2008, 79(6):812-819. Epub 2008/12/17
• [25]Ravi B, Croxford R, Reichmann WM, Losina E, Katz JN, Hawker GA: The changing demographics of total joint arthroplasty recipients in the United States and Ontario from 2001 to 2007. Best Pract Res Clin Rheumatol 2012, 26(5):637-647. Epub 2012/12/12
• [26]Singh JA, Lewallen DG: Time trends in the characteristics of patients undergoing primary total knee arthroplasty. Arthritis Care Res (Hoboken) 2014, 66(6):897-906. doi:10.1002/acr.22233. PubMed PMID: 24249702; PubMed Central PMCID: PMC4151514
• [27]STROBE Statement: Strengthening the Reporting of Observational Studies in Epidemiology. Bern, Germany: University of Bern; 2007. Link: http://www.strobe-statement.org/fileadmin/Strobe/uploads/checklists/STROBE_checklist_v4_cohort.pdf webcite
• [28]Berry DJ, Kessler M, Morrey BF: Maintaining a hip registry for 25 years. Mayo Clinic experience. Clin Orthop Relat Res 1997, 344:61-68. Epub 1997/12/31
• [29]Singh JA, Gabriel SE, Lewallen DG: Higher body mass index is not associated with worse pain outcomes after primary or revision total knee arthroplasty. J Arthroplasty 2011, 26(3):366-374. e361. Epub 2010/04/24. doi:10.1016/j.arth.2010.02.006. PubMed PMID: 20413245; PubMed Central PMCID: PMC2930933
• [30]Singh JA, Gabriel S, Lewallen D: The impact of gender, age, and preoperative pain severity on pain after TKA. Clin Orthop Relat Res 2008, 466(11):2717-2723. Epub 2008/08/06
• [31]WHO: Obesity; Preventing and Managing the Global Epidemic. Geneva: World Health Organization; 2000.
• [32]Deyo RA, Cherkin DC, Ciol MA: Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992, 45(6):613-619. Epub 1992/06/01
• [33]Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 1987, 40(5):373-383.
• [34]Charlson ME, Sax FL, MacKenzie CR, Braham RL, Fields SD, Douglas RG Jr: Morbidity during hospitalization: can we predict it? J Chron Dis 1987, 40(7):705-712.
• [35]Ehlenbach WJ, Barnato AE, Curtis JR, Kreuter W, Koepsell TD, Deyo RA, Stapleton RD: Epidemiologic study of in-hospital cardiopulmonary resuscitation in the elderly. N Engl J Med 2009, 361(1):22-31. Epub 2009/07/03
• [36]Malinzak RA, Ritter MA, Berend ME, Meding JB, Olberding EM, Davis KE: Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates. J Arthroplasty 2009, 24(6 Suppl):84-88.
• [37]da Silva E, Doran MF, Crowson CS, O’Fallon WM, Matteson EL: Declining use of orthopedic surgery in patients with rheumatoid arthritis? Results of a long-term, population-based assessment. Arthritis Rheum 2003, 49(2):216-220.
• [38]Hekmat K, Jacobsson L, Nilsson JA, Petersson IF, Robertsson O, Garellick G, Turesson C: Decrease in the incidence of total hip arthroplasties in patients with rheumatoid arthritis–results from a well defined population in south Sweden. Arthritis Res Ther 2011, 13(2):R67. 3132062: 3132062 BioMed Central Full Text
• [39]O’Dell JR, Haire CE, Erikson N, Drymalski W, Palmer W, Eckhoff PJ, Garwood V, Maloley P, Klassen LW, Wees S, Klein H, Moore GF: Treatment of rheumatoid arthritis with methotrexate alone, sulfasalazine and hydroxychloroquine, or a combination of all three medications. N Engl J Med 1996, 334(20):1287-1291. Epub 1996/05/16
• [40]Gartlehner G, Hansen RA, Jonas BL, Thieda P, Lohr KN: The comparative efficacy and safety of biologics for the treatment of rheumatoid arthritis: a systematic review and metaanalysis. J Rheumatol 2006, 33(12):2398-2408.
• [41]Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, Moreland LW, O’Dell J, Winthrop KL, Beukelman T, Bridges SL Jr, Chatham WW, Paulus HE, Suarez-Almazor M, Bombardier C, Dougados M, Khanna D, King CM, Leong AL, Matteson EL, Schousboe JT, Moynihan E, Kolba KS, Jain A, Volkmann ER, Agrawal H, Bae S, Mudano AS, Patkar NM, Saag KG: 2012 update of the 2008 American college of rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken) 2012, 64(5):625-639. Epub 2012/04/05
• [42]Smolen JS, Landewe R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, Gorter S, Knevel R, Nam J, Schoels M, Aletaha D, Buch M, Gossec L, Huizinga T, Bijlsma JW, Burmester G, Combe B, Cutolo M, Gabay C, Gomez-Reino J, Kouloumas M, Kvien TK, Martin-Mola E, McInnes I, Pavelka K, van Riel P, Scholte M, Scott DL, Sokka T, Valesini G, et al.: EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010, 69(6):964-975. 2935329: 2935329
• [43]Lingard EA, Riddle DL: Impact of psychological distress on pain and function following knee arthroplasty. J Bone Joint Surg Am 2007, 89(6):1161-1169.
• [44]Singh JA, Lewallen DG: Predictors of use of pain medications for persistent knee pain after primary Total Knee Arthroplasty: a cohort study using an institutional joint registry. Arthritis Res Ther 2012, 14(6):R248. BioMed Central Full Text
• [45]Singh JA, Lewallen D: Predictors of pain and use of pain medications following primary Total Hip Arthroplasty (THA): 5,707 THAs at 2-years and 3,289 THAs at 5-years. BMC Musculoskelet Disord 2010, 11:90. 2881019: 2881019 BioMed Central Full Text
• [46]Stundner O, Kirksey M, Chiu YL, Mazumdar M, Poultsides L, Gerner P, Memtsoudis SG: Demographics and perioperative outcome in patients with depression and anxiety undergoing total joint arthroplasty: a population-based study. Psychosomatics 2013, 54(2):149-157.
• [47]Bang H, Chiu YL, Memtsoudis SG, Mandl LA, Della Valle AG, Mushlin AI, Marx RG, Mazumdar M: Total hip and total knee arthroplasties: trends and disparities revisited. Am J Orthop (Belle Mead NJ) 2010, 39(9):E95-E102.