Matched cohort analysis of peri-operative outcomes following total knee arthroplasty in patients with and without Parkinson's disease

Abstract

BackgroundIncreased complication rate has been reported in Parkinson's disease (PD) patients following total knee arthroplasty (TKA). However, this has not previously been studied on a national scale. The purpose of this study was to determine whether PD patients had increased cost, complication, mortality, and length of stay following TKA using a national database. MethodsThe HCUP Nationwide Inpatient Sample was evaluated for the years 2000 to 2012. PD patients were matched 1:10 with non-PD control patients for age, sex, Charlson Comorbidity Index (CCI), and year of admission utilizing a propensity score matching procedure. Univariable and multivariable logistic regression were used to determine the relationship between PD and surgical outcomes in the matched cohort. ResultsBefore matching, TKA patients with PD were significantly older (p < 0.0001), more frequently male (p < 0.0001), and had a greater CCI (p = 0.3058). In the matched cohort, PD was associated with significantly increased length of stay (3.92 vs 3.71 days, p < 0.0001) and total hospital charges ($41,523.52 vs $40,657.00, p = 0.0037). There was no significant difference in in-hospital complication rate (8.28% vs 8.04%, p = 0.4297) or in-hospital mortality (0.164% vs 0.150%, p = 0.8465) between PD patients and matched non-PD patients. ConclusionsMatched cohort analysis demonstrated statistically significant but clinically minor increases in length and cost of hospitalization for TKA in PD patients. Complication rate and in-hospital mortality rate was not higher in PD patients, suggesting that this group may be safely considered for TKA. Level of evidencePrognostic — Level III.