Rheum Round-up: TKA Updates, Racial Disparities in Arthroplasty, and more

Here are the top stories recently covered by DocWire News in the rheumatology section. In this edition, read about the effect of Medicare bundled payment options on black and Hispanic joint arthroplasty patients, racial disparities in total knee arthroplasty (TKA), tourniquet use in TKA, and the effect of mental health on rheumatoid arthritis (RA) medication adherence and disease outcomes.

Medicare’s Comprehensive Care for Joint Replacement model decreased readmissions and discharges to institutional postacute care in black arthroplasty patients, according to a study. “I was surprised the readmission rate decreased for Black patients,” said study author Hyunjee Kim, PhD, in a press release. Despite the improvements, which the researchers said was “a notable finding,” the study authors acknowledged that “Nonetheless, racial/ethnic differences in joint replacement care still persist, indicating the need for additional and sustained efforts to create an equitable health care system.”

Racial and ethnic disparities are still a concern when it comes to total knee arthroplasty (TKA) outcomes, according to an analysis. An analysis of 262,954 patient records was performed, for which racial identification was available for 230,712 patients (87.7%). The rates of comorbidities including diabetes, hypertension, and anemia, as well as prolonged surgery times, were higher among racial and ethnic minority patients. Black/African American patients had significantly evident baseline disparities, including higher rates of tobacco smoking and congestive heart failure. When controlling for baseline differences, significant racial and ethnic disparities were still observed; particularly, black/African American and Hispanic/Latino patients were more likely to sustain complications and require readmission.

The use of a tourniquet in routine primary TKA may put patients at a higher risk of transfusion and longer postoperative length of stay (LOS), according to a study. The study cohort encompassed 6,325 primary unilateral knee arthroplasty patients who were stratified into two groups based on whether a tourniquet was (n=4,902) or was not (n=1,423) used during surgery. The primary outcomes were transfusion and LOS, which were determined using the patients’ electronic health records. The transfusion rate in the tourniquet group was 14.52%, compared to 6.47% when one was not used; postoperative LOS was 7.72 ± 3.54 days and 6.44 ± 3.48 days, respectively. In adjusted analyses, tourniquet use significantly increased the risk for transfusion and was associated with longer postoperative LOS.

Veterans with posttraumatic stress disorder (PTSD), anxiety, and depression on medication for RA may be more likely to discontinue RA therapy, adversely impacting their disease outcomes, according to a study. Researchers collected Veterans Affairs administrative data spanning 2005 through 2014 for veterans with RA who received methotrexate and tumor necrosis factor inhibitors (TNFi). Using diagnosis codes, patients were stratified into three groups: PTSD (with/without depression/anxiety), depression/anxiety without PTSD, and neither PTSD nor depression/anxiety. Time to DMARD discontinuation was defined as a lapse in refill >90 days. Medication nonadherence was defined as proportion of days covered <0.8. A total of 15,081 methotrexate dispensing episodes and 8,412 TNFi dispensing episodes were identified. An independent correlation was identified between PTSD and early discontinuation of methotrexate and TNFi. Discontinuation risk was similar among patients with depression/anxiety for methotrexate and TNFi. Patients with depression/anxiety had higher nonadherence rates for methotrexate and TNFi, but this correlation was not observed in patients with PTSD.