Can the American College of Surgeons Risk Calculator Predict 30-Day Complications After Knee and Hip Arthroplasty?

Adam I Edelstein; Mary J Kwasny; Linda I Suleiman; Rishi H Khakhkhar; Michael A Moore; Matthew D Beal; David W Manning

doi:10.1016/j.arth.2015.01.057

Can the American College of Surgeons Risk Calculator Predict 30-Day Complications After Knee and Hip Arthroplasty?

J Arthroplasty. 2015 Sep;30(9 Suppl):5-10. doi: 10.1016/j.arth.2015.01.057. Epub 2015 May 27.

Authors

Adam I Edelstein¹, Mary J Kwasny², Linda I Suleiman¹, Rishi H Khakhkhar³, Michael A Moore⁴, Matthew D Beal¹, David W Manning¹

Affiliations

¹ Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
² Department of Preventive Medicine, Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
³ Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
⁴ University of Illinois, College of Medicine at Urbana-ChampaignUrbana, Illinois.

PMID: 26165953
DOI: 10.1016/j.arth.2015.01.057

Abstract

Accurate risk stratification of patients undergoing total hip (THA) and knee (TKA) arthroplasty is essential in the highly scrutinized world of pay-for-performance, value-driven healthcare. We assessed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator's ability to predict 30-day complications using 1066 publicly-reported Medicare patients undergoing primary THA or TKA. Risk estimates were significantly associated with complications in the categories of any complication (P = .005), cardiac complication (P < .001), pneumonia (P < .001) and discharge to skilled nursing facility (P < .001). However, predictability of complication occurrence was poor for all complications assessed. To facilitate the equitable provision and reimbursement of patient care, further research is needed to develop accurate risk stratification tools in TKA and THA surgery.

Keywords: complications; hip arthroplasty; knee arthroplasty; risk calculator.

MeSH terms

Arthroplasty, Replacement, Hip / adverse effects*
Arthroplasty, Replacement, Knee / adverse effects*
Cohort Studies
Databases, Factual
Female
Humans
Male
Medicare
Orthopedics / statistics & numerical data*
Patient Discharge
Postoperative Complications / epidemiology*
Probability
Quality Improvement
Regression Analysis
Reimbursement, Incentive
Risk Assessment / methods*
Risk Factors
Societies, Medical
Surgeons
United States