Article Figures & Data
Tables
National Estimates* Entire Cohort, n = 4,116,485* No SSc, n = 4,113,813* SSc, n = 2672* Age, yrs, mean (SE); median 65.2 (0.04); 65.9 65.5 (0.04); 66.0 63.6 (0.54); 64.5 Age category, yrs < 50 449,642 (10.9) 449,321 (10.9) 321 (12.0) 50–64 1,364,821 (33.2) 1,363,891 (33.2) 930 (34.8) 65–79 1,732,014 (42.1) 1,730,790 (42.1) 1224 (45.8) ≥ 80 566,521 (13.8) 566,324 (13.8) 197 (7.4) Sex Female 2,330,188 (56.6) 2,327,919 (56.6) 2269 (84.9) Male 1,776,722 (43.2) 1,776,320 (43.2) 402 (15.1) Race White 2,882,041 (70.0) 2,880,179 (70.0) 1862 (69.7) Black 225,772 (5.5) 225,583 (5.5) 189 (7.1) Hispanic 104,385 (2.5) 104,255 (2.5) 130 (4.9) Other/missing 904,234 (22.0) 903,743 (22.0) 491 (18.4) Deyo-Charlson Score 0 2,193,575 (53.3) 2,193,575 (53.3) 0 (0.0) 1 926,287 (22.5) 924,825 (22.5) 1462 (54.7) ≥ 2 996,624 (24.2) 995,414 (24.2) 1210 (45.3) Primary diagnosis RA 29,174 (0.7) 29,099 (0.7) 75 (2.8) Avascular bone necrosis 285,622 (6.9) 285,200 (6.9) 422 (15.8) Osteoarthritis 3,447,224 (83.7) 3,445,373 (83.8) 1851 (69.3) Other 354,307 (8.6) 353,984 (8.6) 323 (12.1) Fracture 117 (0.0) 117 (0.0) 0 (0.0) Insurance Medicaid 138,809 (3.4) 138,727 (3.4) 82 (3.1) Medicare 2,234,674 (54.3) 2,233,071 (54.3) 1603 (60.0) Other 102,276 (2.5) 102,246 (2.5) 30 (1.1) Private 1,600,830 (38.9) 1,599,902 (38.9) 928 (34.7) Self 32,307 (0.8) 32,293 (0.8) 14 (0.5) Income category 0–25th percentile 653,243 (15.9) 652,828 (15.9) 415 (15.5) 25th–50th percentile 1,009,677 (24.5) 1,009,042 (24.5) 635 (23.8) 50th–75th percentile 1,086,953 (26.4) 1,086,239 (26.4) 714 (26.7) 75th–100th percentile 1,285,855 (31.2) 1,284,984 (31.2) 871 (32.6) Hospital location/teaching Rural 444,188 (10.8) 444,031 (10.8) 157 (5.9) Urban 1,722,390 (41.8) 1,721,393 (41.8) 997 (37.3) Urban teaching 1,939,988 (47.1) 1,938,471 (47.1) 1517 (56.8) Hospital bed size Small 685,209 (16.6) 684,783 (16.6) 426 (15.9) Medium 1,037,562 (25.2) 1,036,856 (25.2) 706 (26.4) Large 2,383,797 (57.9) 2,382,257 (57.9) 1540 (57.6) Hospital region Northeast 818,699 (19.9) 818,058 (19.9) 641 (24.0) Midwest 1,089,883 (26.5) 1,089,259 (26.5) 624 (23.4) South 1,358,856 (33.0) 1,357,985 (33.0) 871 (32.6) West 849,045 (20.6) 848,511 (20.6) 534 (20.0) National Estimates* Entire Cohort, n = 4,116,485* No SSc, n = 4,113,813* SSc, n = 2672* Infection 7592 (0.2) 7588 (0.2) 4 (0.2) Revision 17,931 (0.4) 17,882 (0.4) 49 (1.8) Transfusion 937,803 (22.8) 936,912 (22.8) 891 (33.3) Death 8890 (0.2) 8871 (0.2) 19 (0.7) Discharge status Home 2,448,107 (59.5) 2,446,763 (59.5) 1344 (50.3) Inpatient facility 1,649,103 (40.1) 1,647,798 (40.1) 1305 (48.8) Length of stay, days, mean (SE); median 3.71 (0.01); 2.74 3.73 (0.01); 2.75 4.02 (0.11); 3.00 Length of stay, days** ≤ 3 2,499,883 (60.7) 2,498,544 (60.7) 1339 (50.1) > 3 1,616,602 (39.3) 1,615,270 (39.3) 1332 (49.9) Total hospital charges, US$, mean (SE); median 44,635 (268); 37,658 44,865 (269); 37,791 47,164 (1526); 38,964 1998–2000 23,556 (275); 20,858 23,557 (275); 20,859 21,030 (991); 18,844 2001–2002 29,210 (431); 25,432 29,209 (431); 25,433 31,410 (3509); 24,043 2003–2004 36,086 (598); 31,359 36,083 (599); 31,358 41,392 (4074); 34,920 2005–2006 40,678 (623); 35,383 40,677 (623); 35,382 41,685 (3618); 38,299 2007–2008 47,216 (787); 41,423 47,215 (788); 41,424 48,395 (4782); 38,262 2009–2010 49,918 (1062); 43,304 49,920 (1061); 43,305 47,166 (3034); 39,779 2011–2012 56,395 (848); 48,917 56,390 (848); 48,914 63,758 (4187); 52,486 2013–2014 58,964 (532); 51,157 58,963 (532); 51,156 61,477 (3953); 55,591 Values are n (%) unless otherwise specified.
↵* US national estimates were based on the National Inpatient Sample, a 20% sample of all US hospitalizations; details are available at: www.hcup-us.ahrq.gov/nisoverview.jsp. The actual numbers were entire cohort, n = 855,634; no systemic sclerosis, n = 855,079; and systemic sclerosis, n = 555.
↵** Length of hospital stay dichotomized at 3 days, by rounding off the median of 2.7 days to 3 days.
↵*** Infection was identified by the presence of ICD-9-CM code 711.xx, 730.xx, 996.66, or 996.67. Transfusion was identified with the ICD-9-CM code of 99.0x. Revision was identified with ICD-9-CM codes of 81.53, 00.70, 00.72, 00.73, 84.56, 84.57 or 80.05. SSc: systemic sclerosis; SE: standard error; ICD-9-CM; International Classification of Diseases, 9th revision, Clinical Modification; RA: rheumatoid arthritis.
- Table 2.
Multivariable-adjusted association of SSc and other clinical variables with healthcare use outcomes and in-hospital implant infection, transfusion, revision, and mortality post-primary THA*.
Variables Total Hospital Charges above the Median** Discharge to Non-home Settings Length of Hospital Stay > 3 Days In-hospital Implant Infection In-hospital Transfusion In-hospital Revision Surgery In-hospital Mortality SSc 0.90 (0.76–1.07) 1.25 (1.03–1.50) 1.61 (1.35–1.92) 0.93 (0.22–3.99) 1.54 (1.28–1.84) 9.53 (6.75–13.46) 2.19 (0.99–4.86) Age category, yrs < 50 Ref Ref Ref Ref Ref Ref Ref 50–64 0.86 (0.82–0.90) 1.75 (1.71–1.78) 1.09 (1.08–1.11) 0.97 (0.82–1.16) 1.11 (1.09–1.13) 0.96 (0.84–1.11) 0.77 (0.71–0.83) 65–79 0.88 (0.84–0.93) 3.36 (3.28–3.44) 1.37 (1.35–1.40) 0.93 (0.74–1.15) 1.30 (1.26–1.33) 0.90 (0.76–1.07) 0.90 (0.81–1.01) ≥ 80 1.01 (0.95–1.07) 10.75 (10.46–11.04) 1.95 (1.90–1.99) 0.94 (0.74–1.19) 1.85 (1.80–1.90) 0.92 (0.76–1.11) 2.50 (2.24–2.80) Sex Male Ref Ref Ref Ref Ref Ref Ref Female 0.97 (0.95–1.00) 1.73 (1.71–1.75) 1.20 (1.19–1.21) 0.95 (0.87–1.04) 1.68 (1.66–1.70) 1.01 (0.93–1.09) 0.91 (0.86–0.97) Race/ethnicity White Ref Ref Ref Ref Ref Ref Ref Black 0.61 (0.58–0.64) 1.67 (1.63–1.70) 1.38 (1.35–1.41) 1.16 (0.95–1.41) 1.39 (1.36–1.42) 1.24 (1.05–1.47) 1.07 (0.92–1.24) Hispanic 0.41 (0.39–0.43) 1.40 (1.35–1.44) 1.33 (1.29–1.37) 1.24 (0.96–1.61) 1.33 (1.29–1.37) 1.04 (0.83–1.30) 0.86 (0.73–1.01) Other/missing 2.50 (2.40–2.61) 1.06 (1.05–1.07) 1.39 (1.37–1.40) 1.04 (0.93–1.16) 0.93 (0.92–0.94) 1.10 (1.00–1.22) 1.00 (0.93–1.07) Deyo-Charlson score 0 Ref Ref Ref Ref Ref Ref Ref 1 0.96 (0.93–0.99) 1.20 (1.19–1.22) 0.95 (0.94–0.96) 1.02 (0.91–1.14) 0.96 (0.95–0.97) 0.93 (0.84–1.03) 1.09 (1.02–1.17) ≥ 2 0.75 (0.73–0.78) 0.95 (0.94–0.97) 0.58 (0.58–0.59) 1.04 (0.94–1.16) 0.78 (0.77–0.79) 0.92 (0.83–1.01) 1.46 (1.37–1.55) Primary diagnosis RA Ref Ref Ref Ref Ref Ref Ref Avascular bone necrosis 1.03 (0.89–1.21) 0.89 (0.84–0.95) 0.84 (0.79–0.89) 1.53 (0.65–3.60) 0.82 (0.78–0.88) 1.25 (0.77–2.02) 0.89 (0.59–1.34) Osteoarthritis 0.93 (0.80–1.08) 0.66 (0.62–0.70) 0.51 (0.48–0.54) 0.85 (0.37–1.96) 0.66 (0.62–0.69) 0.84 (0.53–1.32) 0.77 (0.53–1.13) Other 0.98 (0.84–1.14) 1.65 (1.55–1.75) 2.30 (2.18–2.43) 3.70 (1.59–8.59) 1.03 (0.97–1.09) 4.83 (3.04–7.66) 7.22 (4.95–10.53) Fracture 0.66 (0.09–5.03) 11.50 (3.39–39.02) 11.84 (2.55–54.85) Not estimable 1.16 (0.47–2.82) Not estimable Not estimable Insurance payer Private Ref Ref Ref Ref Ref Ref Ref Medicare 0.99 (0.96–1.03) 2.06 (2.02–2.09) 1.34 (1.32–1.36) 1.01 (0.86–1.19) 1.18 (1.16–1.20) 1.04 (0.91–1.18) 1.14 (1.04–1.26) Medicaid 1.38 (1.27–1.51) 1.72 (1.67–1.77) 1.70 (1.65–1.74) 1.76 (1.43–2.17) 1.17 (1.14–1.21) 1.53 (1.28–1.82) 0.89 (0.75–1.05) Other 1.92 (1.72–2.14) 1.10 (1.06–1.14) 1.32 (1.28–1.37) 1.38 (1.06–1.80) 1.00 (0.97–1.04) 1.04 (0.82–1.32) 0.83 (0.69–1.01) Self 1.24 (1.05–1.46) 0.56 (0.52–0.61) 1.50 (1.43–1.58) 1.30 (0.84–2.03) 1.11 (1.04–1.18) 1.41 (1.01–1.95) 0.90 (0.64–1.25) Income category, percentile 0–25th 2.48 (2.38–2.59) 0.81 (0.80–0.82) 0.86 (0.85–0.87) 0.96 (0.84–1.10) 0.82 (0.81–0.84) 0.98 (0.87–1.11) 0.98 (0.90–1.06) 25th–50th 2.19 (2.12–2.27) 0.83 (0.82–0.84) 0.94 (0.93–0.96) 0.99 (0.88–1.11) 0.79 (0.78–0.80) 1.04 (0.94–1.16) 0.99 (0.93–1.07) 50th–75th 1.55 (1.50–1.60) 0.86 (0.85–0.87) 0.91 (0.90–0.92) 0.99 (0.88–1.12) 0.79 (0.78–0.81) 0.99 (0.89–1.10) 0.96 (0.89–1.03) 75th–100th Ref Ref Ref Ref Ref Ref Ref Data are OR (95% CI). Values in bold face indicate significant OR. An OR > 1 indicates that SSc patients had higher odds of that outcome, including in-hospital complication (e.g., mortality) and healthcare use (charges, stay, discharge disposition). A 95% CI that did not include unity (1.0) indicates that the association is statistically significant with a p value < 0.05.
↵* Model included the following variables: age, sex, race, Deyo-Charlson comorbidity index, the underlying primary diagnosis for THA, household income, insurance payer, SSc diagnosis.
↵** Median hospital charges were as follows: 1998, $19,717; 1999, $20,514; 2000, $22,333; 2001, $24,189; 2002, $26,729; 2003, $29,858; 2004, $32,607; 2005, $34,615; 2006, $36,164; 2007, $39,675; 2008, $43,064; 2009, $41,602; 2010, $45,186; 2011, $48,898; 2012, $48,927; 2013, $50,827; 2014, $51,482. SSc: systemic sclerosis; RA: rheumatoid arthritis; THA: total hip arthroplasty.
Total Hospital Charges above the Median Discharge to Non-home Settings Length of Hospital Stay > 3 Days In-hospital Implant Infection In-hospital Transfusion In-hospital Revision Surgery In-hospital Mortality SSc 0.88 (0.74–1.04) 1.23 (1.01–1.48) 1.62 (1.35–1.93) 0.92 (0.22–3.92) 1.54 (1.28–1.85) 9.55 (6.74–13.53) 2.20 (0.97–5.02) Data are OR (95% CI).
↵* Model included age, sex, race, Deyo-Charlson comorbidity index, primary diagnosis, insurance, income, SSc (main model) plus hospital location/teaching status, region, and bed size. Data are OR (95% CI). Values in bold face are statistically significant.
In this issue
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- Abstract
- MATERIALS AND METHODS
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- APPENDIX 1. Sensitivity analyses* adjusting the main multivariable-adjusted models for hospital location/teaching status, region, and bed size, assessing the association of systemic sclerosis (SSc) with healthcare use and in-hospital complications.
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