PMID- 37343282
OWN - NLM
STAT- MEDLINE
DCOM- 20230725
LR  - 20230725
IS  - 1532-8406 (Electronic)
IS  - 0883-5403 (Linking)
VI  - 38
IP  - 7 Suppl 2
DP  - 2023 Jul
TI  - Preoperative Patient-Reported Outcome Measure Thresholds Should Not be Used for 
      Indicating Total Knee Arthroplasty.
PG  - S150-S155
LID - S0883-5403(22)00820-8 [pii]
LID - 10.1016/j.arth.2022.08.039 [doi]
AB  - BACKGROUND: While Medicare requires patient-reported outcome measures (PROMs) for 
      many quality programs, some commercial insurers are requiring preoperative PROMs 
      when determining eligibility for total knee arthroplasty (TKA). Concerns exist 
      that these data may be used to deny TKA to patients above a specific PROM score, 
      but the optimal threshold is unknown. We aimed to evaluate TKA outcomes based on 
      theoretical PROM thresholds. METHODS: We retrospectively analyzed 25,246 
      consecutive primary TKA patients from 2016 to 2019. Hypothesized preoperative 
      knee injury and osteoarthritis outcome score for joint replacement cutoffs of 40, 
      50, 60, and 70 points were used. Preoperative scores below each threshold were 
      considered "approved" surgery. Preoperative scores above each threshold were 
      considered "denied" surgery. In-hospital complications, 90-day readmissions, and 
      discharge disposition were evaluated. One-year minimum clinically important 
      difference (MCID) achievement was calculated using previously validated 
      anchor-based methods. RESULTS: For "denied" patients below thresholds 40, 50, 60, 
      and 70 points, 1-year MCID achievement was 88.3%, 85.9%, 79.6%, and 77%, 
      respectively. In-hospital complication rates for approved patients were 2.2%, 
      2.3%, 2.1%, and 2.1%, while 90-day readmission rates were 4.6%, 4.5%, 4.3%, and 
      4.3%, respectively. Approved patients had higher MCID achievement rates (P < 
      .001) for all thresholds but higher nonhome discharge rates than denied patients 
      for thresholds 40 (P < .001), 50 (P = .002), and 60 (P = .024). Approved and 
      denied patients had similar in-hospital complication and 90-day readmission 
      rates. CONCLUSION: Most patients achieved MCID at all theoretical PROMs 
      thresholds with low complication and readmission rates. Setting preoperative PROM 
      thresholds for TKA eligibility can help optimize patient improvement, but such a 
      policy can create access to care barriers for some patients who would otherwise 
      benefit from a TKA.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Sutton, Ryan M
AU  - Sutton RM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - Baker, Colin M
AU  - Baker CM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - D'Amore, Taylor
AU  - D'Amore T
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - Krueger, Chad A
AU  - Krueger CA
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
FAU - Courtney, P Maxwell
AU  - Courtney PM
AD  - Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, 
      Pennsylvania.
LA  - eng
PT  - Journal Article
DEP - 20221108
PL  - United States
TA  - J Arthroplasty
JT  - The Journal of arthroplasty
JID - 8703515
SB  - IM
MH  - Humans
MH  - Aged
MH  - United States
MH  - *Arthroplasty, Replacement, Knee/adverse effects
MH  - Retrospective Studies
MH  - Treatment Outcome
MH  - Patient Reported Outcome Measures
MH  - Medicare
OTO - NOTNLM
OT  - KOOS-JR.
OT  - MCID
OT  - achievement MCID
OT  - preoperative patient-reported outcome measures
OT  - total knee arthroplasty
EDAT- 2023/06/21 19:15
MHDA- 2023/07/25 06:43
CRDT- 2023/06/21 17:28
PHST- 2022/06/13 00:00 [received]
PHST- 2022/08/18 00:00 [revised]
PHST- 2022/08/26 00:00 [accepted]
PHST- 2023/07/25 06:43 [medline]
PHST- 2023/06/21 19:15 [pubmed]
PHST- 2023/06/21 17:28 [entrez]
AID - S0883-5403(22)00820-8 [pii]
AID - 10.1016/j.arth.2022.08.039 [doi]
PST - ppublish
SO  - J Arthroplasty. 2023 Jul;38(7 Suppl 2):S150-S155. doi: 
      10.1016/j.arth.2022.08.039. Epub 2022 Nov 8.