g protein coupled receptors The transition to a bundled payment model has raised the

The transition to a bundled payment model has raised the national discussion of both the cost and risk of TJA procedures. On the front line of this discussion is the clinician, who is faced with a daily decision to offer or withhold surgery to a wide range of patients who present in various stages of health. In an effort to aid the clinician in proper patient selection and to improve preoperative patient counseling and medical optimization, certain joint registries have created patient risk calculators. Calculators are available on 90-day mortality risk and 2-year periprosthetic joint infection risk from the American Joint Replacement Registry [25] and Medicare Claims Data [16], 5-year revision surgery risk from Kaiser Permanente Joint Registry [26], and postoperative complications and readmission from the American College of Surgeons National Surgical Quality Improvement Program [27]. Yet, despite these powerful tools, none of these calculators include a g protein coupled receptors cost component, and each is limited to a specific subset of the US population. Therefore, to provide clinicians with information on the risk and cost of comorbidities for patients undergoing TJA, we analyzed all arthroplasty procedures in the NIS. NIS data provide both overall hospital costs and in-hospital postoperative complications and mortality. Until now, no study has provided cost and risk data for both primary and revision joints [9].
Our study has certain limitations that potentially affect the generalizability of our findings. In an effort to simplify the interpretation of the large data set, we combined both primary and revision joints into 1 multivariate model, examined only common patient comorbidities, and monitored for only common postoperative in-hospital outcomes. We did this in an effort to provide clinicians with side-by-side comparisons of patient comorbidities in 1 study. By providing large data for common comorbidities, complications, and cost in 1 study, we sought to provide an easy to interpret reference, thereby increasing the clinical applicability of our findings. However, this does limit the ability to examine rare outcomes and rare patient comorbidities. In addition, we were unable to assess the optimization of patients before surgery. It may be that some patients with the same comorbidity burden were treated differently in the perioperative and therefore had different outcomes. Additional studies may choose to further examine rare outcomes from the database, and prospective studies could examine the use of perioperative optimization on mitigation of postoperative complication risk from comorbidity burden. Finally, NIS provides only information on in-hospital outcomes, limiting our ability to offer long-term outcome assessment. Both aseptic loosening and periprosthetic infection are 2 long-term outcomes that greatly affect the outcomes of TJA that we were unable to assess in NIS. Despite some limitations, the NIS provides important data on the association between patient preoperative comorbidities and the in-hospital cost and risk of arthroplasty procedures performed in the United States.
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