title: Can the American College of Surgeons Risk Calculator Predict 30-Day Complications After Knee and Hip Arthroplasty?
abstract: Accurate risk stratification of patients undergoing total hip (THA) and knee (TKA) arthroplasty is essential in the highly scrutinized world of pay-for-performance, value-driven healthcare. We assessed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator's ability to predict 30-day complications using 1066 publicly-reported Medicare patients undergoing primary THA or TKA. Risk estimates were significantly associated with complications in the categories of any complication (P = .005), cardiac complication (P < .001), pneumonia (P < .001) and discharge to skilled nursing facility (P < .001). However, predictability of complication occurrence was poor for all complications assessed. To facilitate the equitable provision and reimbursement of patient care, further research is needed to develop accurate risk stratification tools in TKA and THA surgery.
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Adam I
authors.initials: AI
authors.lastname: Edelstein
authors.affiliation: Department of Preventive Medicine, Division of Biostatistics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Kwasny
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Linda I
authors.initials: LI
authors.lastname: Suleiman
authors.affiliation: Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Rishi H
authors.initials: RH
authors.lastname: Khakhkhar
authors.affiliation: University of Illinois, College of Medicine at Urbana-ChampaignUrbana, Illinois.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Moore
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Beal
authors.affiliation: Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
authors.forename: David W
authors.initials: DW
authors.lastname: Manning
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D009985:Orthopedics / Q000706:statistics & numerical data*; D010351:Patient Discharge; D011183:Postoperative Complications / Q000453:epidemiology*; D011336:Probability; D058996:Quality Improvement; D012044:Regression Analysis; D012052:Reimbursement, Incentive; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012955:Societies, Medical; D066231:Surgeons; D014481:United States
keywords: complications; hip arthroplasty; knee arthroplasty; risk calculator