Christian A Waimann1, Rodrigo J Fernandez-Mazarambroz1, Scott B Cantor1, Maria A Lopez-Olivo1, Andrea G Barbo1, Glenn C Landon1, Sherwin J Siff1, Heather Lin1, Maria E Suarez-Almazor2. 1. From the Hospital Municipal Dr. Héctor M. Cura, Buenos Aires, Argentina; University of Texas MD Anderson Cancer Center; St. Luke's Episcopal Health System, Houston, Texas, USA.C.A. Waimann, MD, Hospital Municipal Dr. Héctor M Cura; R.J. Fernandez-Mazarambroz, BBA, University of Texas MD Anderson Cancer Center; S.B. Cantor, PhD, University of Texas MD Anderson Cancer Center; M.A. Lopez-Olivo, MD, PhD, University of Texas MD Anderson Cancer Center; A.G. Barbo, MS, University of Texas MD Anderson Cancer Center; G.C. Landon, MD, St. Luke's Episcopal Health System; S.J. Siff, MD, St. Luke's Episcopal Health System; H. Lin, PhD, University of Texas MD Anderson Cancer Center; M.E. Suarez-Almazor, MD, PhD, University of Texas MD Anderson Cancer Center. 2. From the Hospital Municipal Dr. Héctor M. Cura, Buenos Aires, Argentina; University of Texas MD Anderson Cancer Center; St. Luke's Episcopal Health System, Houston, Texas, USA.C.A. Waimann, MD, Hospital Municipal Dr. Héctor M Cura; R.J. Fernandez-Mazarambroz, BBA, University of Texas MD Anderson Cancer Center; S.B. Cantor, PhD, University of Texas MD Anderson Cancer Center; M.A. Lopez-Olivo, MD, PhD, University of Texas MD Anderson Cancer Center; A.G. Barbo, MS, University of Texas MD Anderson Cancer Center; G.C. Landon, MD, St. Luke's Episcopal Health System; S.J. Siff, MD, St. Luke's Episcopal Health System; H. Lin, PhD, University of Texas MD Anderson Cancer Center; M.E. Suarez-Almazor, MD, PhD, University of Texas MD Anderson Cancer Center. msalmazor@mdanderson.org.
Abstract
OBJECTIVE: Clinical and psychosocial attributes are associated with clinical outcomes after total knee replacement (TKR) surgery in patients with osteoarthritis (OA), but their relationship with TKR-related costs is less clear. Our objective was to evaluate the effect of clinical and psychosocial attributes on TKR costs. METHODS: We conducted a 6-month prospective cohort study of patients with knee OA who underwent TKR. We examined baseline demographic, clinical [body mass index (BMI) and comorbidities], and psychosocial attributes (social support, locus of control, coping, depression, anxiety, stress, and self-efficacy); baseline and 6-month OA clinical outcomes [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function]; and 6-month direct and indirect TKR-related costs. Multiple regression was performed to identify determinants of TKR-related costs. RESULTS: We included 212 patients; 66% were women, 71% were white, and the mean age was 65.2 years. The mean baseline WOMAC pain score was 55 (SD 19) and WOMAC function score was 54 (SD 20). Mean total TKR-related costs were US$30,831 (SD $9893). Multivariate regression analyses showed that increasing BMI and anxiety levels and decreasing levels of positive social interactions were associated with increased costs. A lower cost scenario with a lower range of normal BMI (19.5), highest positive social interaction, and no anxiety predicted TKR costs to be $22,247. Predicted costs in obese patients (BMI 36) with lowest positive social interaction and highest anxiety were $58,447. CONCLUSION: Increased baseline BMI, anxiety, and poor social support lead to higher TKR-related costs in patients with knee OA. Preoperative interventions targeting these factors may reduce TKR-related costs, and therefore be cost-effective.
OBJECTIVE: Clinical and psychosocial attributes are associated with clinical outcomes after total knee replacement (TKR) surgery in patients with osteoarthritis (OA), but their relationship with TKR-related costs is less clear. Our objective was to evaluate the effect of clinical and psychosocial attributes on TKR costs. METHODS: We conducted a 6-month prospective cohort study of patients with knee OA who underwent TKR. We examined baseline demographic, clinical [body mass index (BMI) and comorbidities], and psychosocial attributes (social support, locus of control, coping, depression, anxiety, stress, and self-efficacy); baseline and 6-month OA clinical outcomes [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function]; and 6-month direct and indirect TKR-related costs. Multiple regression was performed to identify determinants of TKR-related costs. RESULTS: We included 212 patients; 66% were women, 71% were white, and the mean age was 65.2 years. The mean baseline WOMAC pain score was 55 (SD 19) and WOMAC function score was 54 (SD 20). Mean total TKR-related costs were US$30,831 (SD $9893). Multivariate regression analyses showed that increasing BMI and anxiety levels and decreasing levels of positive social interactions were associated with increased costs. A lower cost scenario with a lower range of normal BMI (19.5), highest positive social interaction, and no anxiety predicted TKR costs to be $22,247. Predicted costs in obesepatients (BMI 36) with lowest positive social interaction and highest anxiety were $58,447. CONCLUSION: Increased baseline BMI, anxiety, and poor social support lead to higher TKR-related costs in patients with knee OA. Preoperative interventions targeting these factors may reduce TKR-related costs, and therefore be cost-effective.
Entities:
Keywords:
ECONOMIC EVALUATION; OBESITY; OSTEOARTHRITIS; PSYCHOSOCIAL DETERMINANTS; TOTAL KNEE REPLACEMENT
Authors: Sara A Hoffman; Gwendolyn Ledford; Kenzie A Cameron; Siobhan M Phillips; Christine A Pellegrini Journal: J Clin Nurs Date: 2018-12-10 Impact factor: 3.036
Authors: Stephen S Johnston; Eric Ammann; Robin Scamuffa; Jonathan Samuels; Andrew Stokes; Elliott Fegelman; Chia-Wen Hsiao Journal: Obes Sci Pract Date: 2020-01-13
Authors: Christine A Pellegrini; Gwendolyn Ledford; Sara A Hoffman; Rowland W Chang; Kenzie A Cameron Journal: BMC Musculoskelet Disord Date: 2017-08-01 Impact factor: 2.362