Jordana K. Schmier

Infection Burden for Hip and Knee Arthroplasty in the United States

We quantified the current and historical incidence of periprosthetic infection associated with hip and knee arthroplasty in the United States using the Nationwide Inpatient Sample, as well as corresponding hospitalization charges and length of stay. The rate of infected knee arthroplasties was 0.92%, significantly greater than that of infected hip arthroplasties with 0.88%. Length of stay was significantly longer for infected hip (9.7 days) and knee (7.6 days) arthroplasties compared to uninfected procedures (hip, 4.3 days; knee, 3.9 days) (P < .0001). Hospitalization charges were also significantly greater for infected joint arthroplasties than for uninfected arthroplasties (hips, 1.76 times; knees, 1.52 times) (P < .0001). Urban-non-teaching hospitals experienced the highest burden of infection with 1.18% for hips and 1.26% for knees compared to rural (0.61% for hips and 0.69% for knees) and urban-teaching hospitals (0.73% for hips and 0.77% for knees). We found an increasing number of joint arthroplasties being diagnosed with periprosthetic infection.

Economic Burden of Periprosthetic Joint Infection in the United States

This study characterizes the patient and clinical factors influencing the economic burden of periprosthetic joint infection (PJI) in the United States. The 2001-2009 Nationwide Inpatient Sample was used to identify total hip and knee arthroplasties using International Classification of Diseases, Ninth Revision, procedure codes. The relative incidence of PJI ranged between 2.0% and 2.4% of total hip arthroplasties and total knee arthroplasties and increased over time. The mean cost to treat hip PJIs was

Future clinical and economic impact of revision total hip and knee arthroplasty

5965 greater than the mean cost for knee PJIs. The annual cost of infected revisions to US hospitals increased from

Recommendations for Evaluating Compliance and Persistence With Hypertension Therapy Using Retrospective Data

320 million to

Mortality following the diagnosis of a vertebral compression fracture in the Medicare population.

566 million during the study period and was projected to exceed

Primary and Revision Arthroplasty Surgery Caseloads in the United States from 1990 to 2004

1.62 billion by 2020. As the demand for joint arthroplasty is expected to increase substantially over the coming decade, so too will the economic burden of prosthetic infections.

The impact of inadequately controlled asthma in urban children on quality of life and productivity

A recent analysis of historical procedure data indicated that the prevalence of primary and revision total hip and total knee arthroplasty increased steadily between 1990 and 20021. A massive demand for primary and revision surgeries is also expected in the next two decades2. Similarly, the overall incidence of deep infection also has increased substantially between 1990 and 2003 for both total hip arthroplasty and total knee arthroplasty3. In 2003, approximately 1.2% of the total hip arthroplasties performed in the United States were associated with deep infection, which was similar to the rate seen for total knee arthroplasties3. Deep infection is a catastrophic complication of both total hip and total knee arthroplasty, and it also represents a tremendous economic burden4,5. The implications for a growing incidence of infections, coupled with accelerating demand for arthroplasty, remain unexplored. Long-term survival of total hip arthroplasty and total knee arthroplasty implants has been investigated by Scandinavian arthroplasty registries6-8. However, in the United States, national hip and knee registries have not been established9,10. Medicare claims data have been used effectively in longitudinal analysis of mortality and morbidity following joint replacement11, but the feasibility of using this data as a registry substitute is unclear. Along with the projected increase in the utilization of total hip arthroplasty and total knee arthroplasty2, retrospective studies have shown increasing disparity between Medicare reimbursement and hospital charges, with higher charges for revision than for primary procedures12-14. The economic consequences of the projected demand for total hip arthroplasty and total knee arthroplasty are still unknown. The goals of our study were to (1) quantify the future number of infections at the site of arthroplasties done …

Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients.

Hypertension is a major risk factor for cardiovascular and cerebrovascular disease. The World Health Organization Global Burden of Disease Study estimates that nonoptimal blood pressure [(BP) ie, systolic BP of >115 mm Hg] is responsible annually for 7.1 million deaths and the loss of 64.3 disability-adjusted life years worldwide.1 The associated economic burden of hypertension is also substantial. The average annual medical care cost for individuals with hypertension has been estimated at

Allergic Rhinitis: A Potential Cause of Increased Asthma Medication Use, Costs, and Morbidity

3900 (in year 2000 US dollars) in Canada,2 with similar values (

The Impact of Asthma on Health-Related Quality of Life

3787) for the United States.3 The increase in medical care costs is greater for those with moderate-to-severe BP elevation (diastolic BP >104 mm Hg) than for those with mild disease.4 Although a broad range of hypertension medications have been demonstrated to reduce BP, and BP control is an achievable goal,5 reports suggest that up to two thirds of patients with hypertension are not successfully treated, that is, achieve BP control.6–8 According to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7), BP control rates are far below the “healthy people” goal of 50% set in 2000.9 A major (and modifiable) reason for lack of BP control is failure by patients to use medications as prescribed.10 Appropriate use of medications includes compliance, taking medications at the prescribed frequency/interval and dose/dosing regimen, and persistence, continuing their use for the specified treatment time period, which, in the case of hypertension therapy, is usually lifelong.11 Poor compliance with hypertension medications is associated with adverse health outcomes.12 Studies have demonstrated that poor BP control is associated with greater healthcare costs.13 For example, in the United States, inadequate control of hypertension has been estimated to result in &40 000 cardiovascular events, >8000 …