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A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty.

Publication ,  Journal Article
Ryan, SP; Wu, CJ; Plate, JF; Bolognesi, MP; Jiranek, WA; Seyler, TM
Published in: J Arthroplasty
January 2021

BACKGROUND: The Center for Medicare and Medicaid Services is faced with a challenge of decreasing the cost of care for total knee arthroplasty (TKA) but must make efforts to prevent patient selection bias in the process. Currently, no appropriate modifier codes exist for primary TKA based on case complexity. We sought to determine differences in perioperative parameters for patients with complex primary TKA with the hypothesis that they would require increased cost of care, prolonged care times, and have worse postoperative outcome metrics. METHODS: We performed a single-center retrospective review from 2015 to 2018 of all primary TKAs. Patient demographics, medial proximal tibial angle (mPTA), lateral distal femoral angle (lDFA), flexion contracture, cost of care, and early postoperative outcomes were collected. Complex patients were defined as those requiring stems or augments, and multivariable logistic regression analysis and propensity score matching were performed to evaluate perioperative outcomes. RESULTS: About 1043 primary TKAs were studied, and 84 patients (8.3%) were deemed complex. For this cohort, surgery duration was greater (P < .001), cost of care higher (P < .001), and patients had a greater likelihood for 90-day hospital return. Deviation of mPTA and lDFA was significantly greater preoperatively before and after propensity score matching. Cut point analysis demonstrated that preoperative mPTA <83o or >91o, lDFA <84o or >90o, flexion contracture >10o, and body mass index >35.7 were associated with complex procedures. CONCLUSION: Complex primary TKA may be identifiable preoperatively and those cases associated with prolonged operative time, excess hospital cost of care, and increased 90-day hospital returns. This should be considered in future reimbursement models to prevent patient selection bias, and a complexity modifier is warranted.

Duke Scholars

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

January 2021

Volume

36

Issue

1

Start / End Page

37 / 41

Location

United States

Related Subject Headings

  • United States
  • Tibia
  • Retrospective Studies
  • Osteoarthritis, Knee
  • Orthopedics
  • Medicare
  • Knee Joint
  • Humans
  • Arthroplasty, Replacement, Knee
  • Aged
 

Citation

APA
Chicago
ICMJE
MLA
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Ryan, S. P., Wu, C. J., Plate, J. F., Bolognesi, M. P., Jiranek, W. A., & Seyler, T. M. (2021). A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty. J Arthroplasty, 36(1), 37–41. https://doi.org/10.1016/j.arth.2020.07.066
Ryan, Sean P., Christine J. Wu, Johannes F. Plate, Michael P. Bolognesi, William A. Jiranek, and Thorsten M. Seyler. “A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty.J Arthroplasty 36, no. 1 (January 2021): 37–41. https://doi.org/10.1016/j.arth.2020.07.066.
Ryan SP, Wu CJ, Plate JF, Bolognesi MP, Jiranek WA, Seyler TM. A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty. J Arthroplasty. 2021 Jan;36(1):37–41.
Ryan, Sean P., et al. “A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty.J Arthroplasty, vol. 36, no. 1, Jan. 2021, pp. 37–41. Pubmed, doi:10.1016/j.arth.2020.07.066.
Ryan SP, Wu CJ, Plate JF, Bolognesi MP, Jiranek WA, Seyler TM. A Case Complexity Modifier Is Warranted for Primary Total Knee Arthroplasty. J Arthroplasty. 2021 Jan;36(1):37–41.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

January 2021

Volume

36

Issue

1

Start / End Page

37 / 41

Location

United States

Related Subject Headings

  • United States
  • Tibia
  • Retrospective Studies
  • Osteoarthritis, Knee
  • Orthopedics
  • Medicare
  • Knee Joint
  • Humans
  • Arthroplasty, Replacement, Knee
  • Aged