PMID- 36047698 OWN - NLM STAT- MEDLINE DCOM- 20221118 LR - 20230714 IS - 1535-1386 (Electronic) IS - 0021-9355 (Linking) VI - 104 IP - 22 DP - 2022 Nov 16 TI - The Impact of Surgeon Variability on Patient-Reported Outcome Measures, Length of Stay, Discharge Disposition, and 90-Day Readmission in TKA. PG - 2016-2025 LID - 10.2106/JBJS.21.01339 [doi] AB - BACKGROUND: Studies involving total knee arthroplasty (TKA) have focused on patient-related factors as drivers of outcomes. Although some studies have investigated surgeon and/or surgery-level factors (i.e., approach, volume), the measure of variance in postoperative outcomes across surgeons following TKA has not been determined. The aim of the current study was to evaluate the relationship between the surgeon and 1-year patient-reported outcome measures, the length of stay, the discharge disposition, and 90-day readmission after TKA, as well as the differences in these variables among surgeons. METHODS: Data were prospectively collected for 5,429 patients who underwent TKA at a large health-care system with 36 surgeons between 2016 and 2018. Likelihood ratio tests were performed to investigate the relationship between surgeon and the 1-year Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain subscale, KOOS-Physical Function Shortform (KOOS-PS), KOOS for Joint Replacement (KOOS-JR), patient acceptable symptom state (PASS), length of stay, discharge disposition, and 90-day readmission. The minimal clinically important difference (MCID) was used to assess meaningful outcomes. Variable importance was determined by the Akaike information criterion (AIC) increase, using ordinal and binary-response mixed-effect models. RESULTS: There was a significant association between surgeon and KOOS-Pain (p < 0.001), KOOS-PS (p = 0.001), KOOS-JR (p < 0.001), PASS (p = 0.024), length of stay (p < 0.001), discharge disposition (p < 0.001), and 90-day readmission (p < 0.001). When modeling 1-year KOOS-Pain (AIC increase, 15.6), KOOS-PS (AIC increase, 6.8), KOOS-JR (AIC increase, 13.5), PASS (AIC increase, 1.9), length of stay, and discharge disposition, the surgeon variable contributed more to the 1-year outcome than some patient-level factors (e.g., body mass index, Charlson Comorbidity Index). The difference between the highest and lowest median probabilities of attaining the same value for the KOOS-Pain (11.2%), KOOS-PS (9.4%), KOOS-JR (11.8%), PASS (5.9%), length of stay (46.6%), discharge disposition (22.8%), and readmission (13.1%) indicated surgeon-level variability. CONCLUSIONS: Surgeon-related factors may be stronger contributors to the 1-year patient-reported outcome measures and length of stay than patient characteristics emphasized in the literature. Current findings have suggested variability in patient-reported outcome measures, length of stay, discharge location, and 90-day readmission among surgeons. Surgeon variability should be considered when model-fitting in the setting of TKA. LEVEL OF EVIDENCE: Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence. CI - Copyright (c) 2022 by The Journal of Bone and Joint Surgery, Incorporated. FAU - Sinclair, SaTia T AU - Sinclair ST AUID- ORCID: 0000-0003-1042-1485 AD - Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. AD - Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio. AD - Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida. AD - Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio. FAU - Klika, Alison K AU - Klika AK AUID- ORCID: 0000-0003-2755-0742 AD - Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. FAU - Jin, Yuxuan AU - Jin Y AUID- ORCID: 0000-0002-5240-6219 AD - Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio. FAU - Higuera, Carlos A AU - Higuera CA AD - Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida. FAU - Piuzzi, Nicolas S AU - Piuzzi NS AD - Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio. AD - Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, Ohio. CN - on behalf of the Cleveland Clinic OME Arthroplasty Group LA - eng PT - Journal Article DEP - 20220831 PL - United States TA - J Bone Joint Surg Am JT - The Journal of bone and joint surgery. American volume JID - 0014030 SB - IM MH - Humans MH - *Arthroplasty, Replacement, Knee MH - Length of Stay MH - Patient Discharge MH - Patient Readmission MH - Patient Reported Outcome Measures MH - *Surgeons MH - Pain/surgery MH - Treatment Outcome MH - *Osteoarthritis, Knee/surgery COIS- Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H223 ). FIR - Brooks, Peter J IR - Brooks PJ FIR - Muschler, George F IR - Muschler GF FIR - Hampton, Robert J IR - Hampton RJ FIR - Greene, Kenneth A IR - Greene KA FIR - George, Joseph W IR - George JW FIR - Parker, Richard D IR - Parker RD FIR - Kolczun, Michael W IR - Kolczun MW FIR - Masin, Richard R IR - Masin RR FIR - Serna, Alfred IR - Serna A FIR - Krahe, David H IR - Krahe DH FIR - Sabo, Frank M IR - Sabo FM FIR - McLaughlin, John P IR - McLaughlin JP FIR - Patterson, Brendan M IR - Patterson BM FIR - McCoy, Brett W IR - McCoy BW FIR - Nemeth, Victor A IR - Nemeth VA FIR - Nystrom, Lukas M IR - Nystrom LM FIR - Matko, Andrew J IR - Matko AJ FIR - Sziraky, Patrick E IR - Sziraky PE FIR - Scarcella, Joseph B IR - Scarcella JB FIR - Joyce, Michael J IR - Joyce MJ FIR - Pierce, Bradley A IR - Pierce BA FIR - Lietman, Steven A IR - Lietman SA FIR - Barsoum, Wael K IR - Barsoum WK FIR - Riesgo, Aldo M IR - Riesgo AM FIR - Suarez, Juan C IR - Suarez JC FIR - Mont, Michael A IR - Mont MA FIR - Strnad, Gregory J IR - Strnad GJ FIR - Molloy, Robert M IR - Molloy RM FIR - Patel, Preetesh D IR - Patel PD FIR - Schaffer, Jonathan L IR - Schaffer JL FIR - Murray, Trevor G IR - Murray TG FIR - Stearns, Kim L IR - Stearns KL FIR - Krebs, Viktor E IR - Krebs VE FIR - Nickodem, Robert J IR - Nickodem RJ FIR - Bloomfield, Michael R IR - Bloomfield MR FIR - Mesko, Nathan W IR - Mesko NW FIR - Spindler, Kurt P IR - Spindler KP EDAT- 2022/09/02 06:00 MHDA- 2022/11/19 06:00 CRDT- 2022/09/01 08:03 PHST- 2022/09/02 06:00 [pubmed] PHST- 2022/11/19 06:00 [medline] PHST- 2022/09/01 08:03 [entrez] AID - 00004623-202211160-00008 [pii] AID - 10.2106/JBJS.21.01339 [doi] PST - ppublish SO - J Bone Joint Surg Am. 2022 Nov 16;104(22):2016-2025. doi: 10.2106/JBJS.21.01339. Epub 2022 Aug 31.