Impact of diabetes on 90-day episodes of care after elective total joint arthroplasty among Medicare beneficiaries
Annalisa Na, PhD, DPT, Addie Middleton, PhD, DPT, Allen Haas, MS, James Graham, PhD, DC, and Kenneth J. Ottenbacher, PhD, OTRHip Knee
Background:
In an effort to improve quality and reduce costs, reimbursement for total knee arthroplasty (TKA) and total hip arthroplasty (THA) is based on the value of care provided, with adjustments for some qualifying comorbidities, including diabetes in its most severe form and excluding many diabetes codes. The study aims to examine the effects of diabetes on elective TKA or THA complication and readmission risks among Medicare beneficiaries.
Methods:
Complications (N = 521,230) and readmissions (N = 515,691) data were extracted from 2013–2014 Medicare files. Diabetes status (no diabetes, controlled-uncomplicated diabetes, controlled-complicated diabetes, and uncontrolled diabetes) was identified with ICD-9 codes. TKA or THA complications and readmissions odds based on diabetes status were estimated using logistical regression and adjusted for sociodemographic and clinical characteristics including comorbidities.
Results:
Compared to no diabetes, odds ratio (OR) of TKA complications were significant for uncontrolled diabetes, OR (95% CI) = 1.29 (1.06, 1.57). Odds of THA complications were significant for controlled-uncomplicated diabetes, 1.08 (1.00, 1.17), and controlled-complicated diabetes, 1.45 (1.17, 1.80). Readmission odds were significant for all diabetes groups (TKA: ORs = 1.21 to 1.48; THA = 1.20 to 1.70).
Conclusion:
Readmission odds were higher in all diabetes categories. The uncontrolled-diabetes group had the greatest TKA readmission and complication odds. The controlled-complicated diabetes group had the greatest THA readmission and complication odds. Findings suggest that cost adjustments in alternative payment models for arthroplasty should consider including diabetes and associated systemic complications.
Level of evidence:
Level III
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