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Comparative Study
. 2013 Jul;65(7):1095-102.
doi: 10.1002/acr.21953.

Sex and surgical outcomes and mortality after primary total knee arthroplasty: a risk-adjusted analysis

Jasvinder A Singh  1 , C Kent Kwoh, Diane Richardson, Wei Chen, Said A Ibrahim
Affiliations
Comparative Study

Sex and surgical outcomes and mortality after primary total knee arthroplasty: a risk-adjusted analysis

Jasvinder A Singh et al. Arthritis Care Res (Hoboken). 2013 Jul.

Abstract

Objective: Total knee arthroplasty (TKA) is a widely utilized and effective treatment option for end-stage knee osteoarthritis (OA). Knee OA is more prevalent among women compared to men, but there are limited data on the sex differences in surgical outcomes after primary TKA.

Methods: Our sample consisted of all primary TKAs performed in Pennsylvania during the fiscal year 2002. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify major complications and surgical revision. We used mixed-effects logistic regression models to examine the associations between sex and all-cause mortality, readmissions, and major surgical complications. We used proportional hazards models to assess the risk of surgical revision after index arthroplasty. We adjusted for race, age, hospital teaching status, hospital procedure volume, insurance status, and risk of mortality.

Results: In 17,994 primary TKAs, there were 46 and 220 deaths at 30 days and 1 year, respectively. Compared to women, men had higher adjusted odds of 1-year mortality (odds ratio [OR] 1.48 [95% confidence interval (95% CI) 1.13-1.94]) after primary TKA. The overall odds of most major 30-day complications did not differ by sex except for surgical wound infections, which were higher in men compared to women (OR 1.31 [95% CI 1.08-1.60]); 30-day readmission was higher in men (OR 1.25 [95% CI 1.10-1.43]). Men had significantly higher rates of revision of index knee arthroplasty at 5 years (hazard ratio 1.20 [95% CI 1.05-1.36]) compared to women.

Conclusion: The higher rates of mortality, hospital readmissions, revision surgery, and wound infections in men undergoing elective primary TKA compared to women indicate there is a sex disparity in these outcomes.

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Figures

Figure 1
Figure 1
Patient Selection Flow Chart
Figure 2
Figure 2
Adjusted Odds Ratios for Complications within 30 days in Males post primary total knee arthroplasty (TKA), with Females as reference category Analyses were adjusted for age category, race, surgical risk category, insurance group, teaching status and hospital procedure volume
Figure 3
Figure 3
Adjusted Odds Ratio (OR) for 30-day Readmission and 1-year Mortality and adjusted Hazard ratio (HR) for 5-year revision rate in Males after knee arthroplasty, with Females as reference category Analyses were adjusted for age category, race, surgical risk category, insurance group, teaching status and hospital procedure volume
See this image and copyright information in PMC

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