The incidence of upper and lower extremity surgery for rheumatoid arthritis among Medicare beneficiaries.
BACKGROUND
For elderly patients with rheumatoid arthritis, aggressive immunosuppression can be difficult to tolerate, and surgery remains an important treatment option for joint pain and deformity. We sought to examine the epidemiology of surgical reconstruction for rheumatoid arthritis among older individuals who were newly diagnosed with the disorder.


METHODS
We identified a 5% random sample of Medicare beneficiaries (sixty-six years of age and older) newly diagnosed with rheumatoid arthritis from 2000 to 2005, and followed these patients longitudinally for a mean of 4.6 years. We used univariate analysis to compare the time from the diagnosis of rheumatoid arthritis to the first operation among the 360 patients who underwent surgery during the study period.


RESULTS
In our study cohort, 589 procedures were performed among 360 patients, and 132 patients (37%) underwent multiple procedures. The rate of upper extremity reconstruction was 0.9%, the rate of lower extremity reconstruction was 1.2%, and knee arthroplasty was the most common procedure performed initially (31%) and overall (29%). Upper extremity procedures were performed sooner than lower extremity procedures (fourteen versus twenty-five months; p = 0.02). In multivariable analysis, surgery rates declined with age for upper and lower extremity procedures (p < 0.001).


CONCLUSIONS
Knee replacement remains the most common initial procedure among patients with rheumatoid arthritis. However, upper extremity procedures are performed earlier than lower extremity procedures. Understanding the patient and provider factors that underlie variation in procedure rates can inform future strategies to improve the delivery of care to patients with rheumatoid arthritis.
Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung: kecchung@med.umich.edu.
Jennifer
J
Waljee
Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung: kecchung@med.umich.edu.
Lin
L
Zhong
Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung: kecchung@med.umich.edu.
Onur
O
Baser
Department of Mathematics, New York City College of Technology, 300 Jay Street, N826, Brooklyn, NY 11201.
Huseyin
H
Yuce
Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung: kecchung@med.umich.edu.
David A
DA
Fox
Section of Plastic Surgery, Department of Surgery (J.W., L.Z., and K.C.C.), and Department of Internal Medicine (O.B. and D.A.F.), University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5340. E-mail address for K.C. Chung: kecchung@med.umich.edu.
Kevin C
KC
Chung
D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000453:epidemiology / Q000601:surgery*; D019643:Arthroplasty, Replacement / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data*; D012086:Reoperation; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D034941:Upper Extremity / Q000601:surgery*