Risk Adjustment Is Necessary in Value-based Outcomes Models for Infected TKA

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Public Health Policy

Background:

• The Medicare Access and CHIP Reauthorization Act of 2015 links provider reimbursement to outcome metrics.
• Concerns exist regarding access to care for revision total knee arthroplasty (TKA) patients with infections due to a lack of risk adjustment.

Purpose of the Study:

• To determine if patients undergoing revision TKA for infection have higher 30-day readmission, reoperation, and mortality rates than those undergoing revision for aseptic causes.
• To assess if patients undergoing revision for infected TKAs face increased risk for complications compared to those undergoing revision for non-infectious causes.

Main Methods:

• Utilized the American College of Surgeons National Surgical Quality Improvement Program database (2012-2015).
• Included 10,848 patients undergoing revision TKA (CPT codes 27486, 27487, 27488), excluding those with malignancy.
• Compared outcomes between infected and aseptic revision TKA groups using multivariate logistic regression.

Main Results:

• Revision TKA for infection was independently associated with higher rates of complications (OR 3.74), 30-day readmission (OR 1.46), 30-day reoperation (OR 1.61), and 30-day mortality (OR 3.34).
• Infected TKA patients had significantly increased risks for postoperative infection (OR 3.82), renal failure (OR 36.71), sepsis (OR 7.58), and septic shock (OR 3.03).

Conclusions:

• Policymakers must recognize the elevated mortality, readmission, reoperation, and complication rates in patients with infected TKA.
• Without appropriate risk adjustment or exclusion, reimbursement and quality models may disincentivize providers from treating patients with infected TKA.