Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis

Mohamed Mosaad Hasan; Raymond Kang; Jungwha Lee; Matthew D. Beal; Abdalrahman G. Ahmed; Yao Tian; Hassan M.K. Ghomrawi

doi:10.1186/s12891-022-05945-y

Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis

Mohamed Mosaad Hasan, Raymond Kang, Jungwha Lee, Matthew D. Beal, Abdalrahman G. Ahmed, Yao Tian, Hassan M.K. Ghomrawi^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Scopus citations

Abstract

Study objective: To describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay. Design: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS). Setting: SPARCS from March 1, 2016, to July 1, 2017. Participants: Adults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery. Interventions: Electrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urinalysis, Urine culture) were identified. Primary and secondary outcome measures: Regression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities. Results: Fifty-five thousand ninety-nine patients (60% Female, mean age 66.1+/− 9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBC antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). Carrying out MRSA testing, urine culture, and EKG was associated with a lower likelihood of 90-day all-cause readmissions. The length of hospital stay was not associated with carrying out any preoperative tests. Results were similar in the subset with no comorbidities. Conclusions: Wide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.

Original language	English (US)
Article number	972
Journal	BMC Musculoskeletal Disorders
Volume	23
Issue number	1
DOIs	https://doi.org/10.1186/s12891-022-05945-y
State	Published - Dec 2022

Funding

This publication was produced from raw data purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived and views expressed herein are those of the authors and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty, or guarantee regarding the accuracy, completeness, currency, or suitability of the information provided here. This research did not receive any specific grant from public, commercial, or not-for-profit funding agencies.

Keywords

Asymptomatic bacteriuria
MRSA screening
Preoperative EKG
Preoperative testing
Total hip replacement
Total knee replacement

ASJC Scopus subject areas

Rheumatology
Orthopedics and Sports Medicine

Access to Document

10.1186/s12891-022-05945-y

Cite this

Hasan, M. M., Kang, R., Lee, J., Beal, M. D., Ahmed, A. G., Tian, Y., & Ghomrawi, H. M. K. (2022). Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis. BMC Musculoskeletal Disorders, 23(1), Article 972. https://doi.org/10.1186/s12891-022-05945-y

@article{3d4e8efadfc244f69e638961b5203b2e,

title = "Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis",

abstract = "Study objective: To describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay. Design: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS). Setting: SPARCS from March 1, 2016, to July 1, 2017. Participants: Adults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery. Interventions: Electrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urinalysis, Urine culture) were identified. Primary and secondary outcome measures: Regression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities. Results: Fifty-five thousand ninety-nine patients (60% Female, mean age 66.1+/− 9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBC antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). Carrying out MRSA testing, urine culture, and EKG was associated with a lower likelihood of 90-day all-cause readmissions. The length of hospital stay was not associated with carrying out any preoperative tests. Results were similar in the subset with no comorbidities. Conclusions: Wide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.",

keywords = "Asymptomatic bacteriuria, MRSA screening, Preoperative EKG, Preoperative testing, Total hip replacement, Total knee replacement",

author = "Hasan, {Mohamed Mosaad} and Raymond Kang and Jungwha Lee and Beal, {Matthew D.} and Ahmed, {Abdalrahman G.} and Yao Tian and Ghomrawi, {Hassan M.K.}",

note = "Funding Information: This publication was produced from raw data purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived and views expressed herein are those of the authors and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty, or guarantee regarding the accuracy, completeness, currency, or suitability of the information provided here. This research did not receive any specific grant from public, commercial, or not-for-profit funding agencies. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = dec,

doi = "10.1186/s12891-022-05945-y",

language = "English (US)",

volume = "23",

journal = "BMC Musculoskeletal Disorders",

issn = "1471-2474",

publisher = "BioMed Central",

number = "1",

}

Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis. / Hasan, Mohamed Mosaad; Kang, Raymond; Lee, Jungwha et al.
In: BMC Musculoskeletal Disorders, Vol. 23, No. 1, 972, 12.2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis

AU - Hasan, Mohamed Mosaad

AU - Kang, Raymond

AU - Lee, Jungwha

AU - Beal, Matthew D.

AU - Ahmed, Abdalrahman G.

AU - Tian, Yao

AU - Ghomrawi, Hassan M.K.

N1 - Funding Information: This publication was produced from raw data purchased from or provided by the New York State Department of Health (NYSDOH). However, the conclusions derived and views expressed herein are those of the authors and do not reflect the conclusions or views of NYSDOH. NYSDOH, its employees, officers, and agents make no representation, warranty, or guarantee regarding the accuracy, completeness, currency, or suitability of the information provided here. This research did not receive any specific grant from public, commercial, or not-for-profit funding agencies. Publisher Copyright: © 2022, The Author(s).

PY - 2022/12

Y1 - 2022/12

N2 - Study objective: To describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay. Design: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS). Setting: SPARCS from March 1, 2016, to July 1, 2017. Participants: Adults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery. Interventions: Electrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urinalysis, Urine culture) were identified. Primary and secondary outcome measures: Regression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities. Results: Fifty-five thousand ninety-nine patients (60% Female, mean age 66.1+/− 9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBC antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). Carrying out MRSA testing, urine culture, and EKG was associated with a lower likelihood of 90-day all-cause readmissions. The length of hospital stay was not associated with carrying out any preoperative tests. Results were similar in the subset with no comorbidities. Conclusions: Wide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.

AB - Study objective: To describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay. Design: Retrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS). Setting: SPARCS from March 1, 2016, to July 1, 2017. Participants: Adults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery. Interventions: Electrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urinalysis, Urine culture) were identified. Primary and secondary outcome measures: Regression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities. Results: Fifty-five thousand ninety-nine patients (60% Female, mean age 66.1+/− 9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBC antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). Carrying out MRSA testing, urine culture, and EKG was associated with a lower likelihood of 90-day all-cause readmissions. The length of hospital stay was not associated with carrying out any preoperative tests. Results were similar in the subset with no comorbidities. Conclusions: Wide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.

KW - Asymptomatic bacteriuria

KW - MRSA screening

KW - Preoperative EKG

KW - Preoperative testing

KW - Total hip replacement

KW - Total knee replacement

UR - http://www.scopus.com/inward/record.url?scp=85141576109&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85141576109&partnerID=8YFLogxK

U2 - 10.1186/s12891-022-05945-y

DO - 10.1186/s12891-022-05945-y

M3 - Article

C2 - 36357880

AN - SCOPUS:85141576109

SN - 1471-2474

VL - 23

JO - BMC Musculoskeletal Disorders

JF - BMC Musculoskeletal Disorders

IS - 1

M1 - 972

ER -

Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this