tja outcomes in immunocompromised patients a matched pair
play

TJA Outcomes in Immunocompromised Patients: A Matched-Pair Analysis - PowerPoint PPT Presentation

TJA Outcomes in Immunocompromised Patients: A Matched-Pair Analysis Controlling for Comorbidity Grace Plassche, Ariel Silverman, Suhas Masilamani Abel Boenerjous, MD, Morteza Meftah, MD, Ira H. Kirschenbaum, MD Background HIV and Hepatitis


  1. TJA Outcomes in Immunocompromised Patients: A Matched-Pair Analysis Controlling for Comorbidity Grace Plassche, Ariel Silverman, Suhas Masilamani Abel Boenerjous, MD, Morteza Meftah, MD, Ira H. Kirschenbaum, MD

  2. Background • HIV and Hepatitis are immunocompromising diseases that appear to negatively affect the results of total hip and knee arthroplasties • These results have been mixed in the literature • The impact of comorbidities has not been fully addressed

  3. Material and Methods 850 Consecutive Total Joint Arthroplasties b/w 2008-2014, min. 2 yr follow-up Hepatitis HIV 31 122 32 665 Controls

  4. Groups Analyzed Comorbidities • Study Group 1 – 108 HIV and/or Hepatitis patients – Matched 1:1 with controls • Sex, Age, BMI, & Procedure • Study Group 2 – 66 HIV and/or Hepatitis patients – Matched 1:1 with controls • Sex, Age, BMI, Procedure & Major Comorbidities

  5. Comorbidities • Diabetes • Smoking • Renal Disease • Asthma • Cardiac Conditions

  6. Negative Outcomes Definitions • Revision • Complication – Prosthetic Joint Infection – Post-op Medical Complications – Neurovascular Complications

  7. Results in Study/Control Group 1 (Not Controlling for Comorbidities) • Results worse in the HIV/Hepatitis group (P=0.0391, n=108) Complications Revisions Study Group- 24.1% Study Group- 10.2% Control Group- 16.7% Control Group 2.8% Average Average Number of Number of Number of Number of Age BMI Complications Revisions Smokers (Y/F) Diabetes Control: 57.5 31.9 18 (16.7%) 3 (2.8%) 41/17 27 108 Study: 57.3 31.6 26 (24.07%) 11 (10.2%) 48/17 30 108

  8. Results in Study/Control Group 2 (Controlling for Comorbidities) • Results are not statistically significant in the immunocompromised group (P=0.2311, n=66) Complications Revisions Study Group- 15.2% Study Group- 4.6% Control Group- 10.6% Control Group 1.5% Average Average Number of Number of Number of Number of Age BMI Complications Revisions Smokers (Y/F) Diabetes Control: 56.682 30.3 7 (10.61%) 1 (1.52%) 24/14 12 66 Study: 56.981 30.8 10 (15.15%) 3 (4.55%) 32/9 12 66

  9. Study Specifics • This was a large single center study • Urban setting where patients all came from the same catchment area • While HIV and Hepatitis have been looked at separately, the role of comorbidities have not previously been fully appreciated • There is a wide range of comorbidities in this population • Differs from previous study…

  10. 2017 JBJS Study Our Study Total Number of 137,801 850 Patients Number of Not Infected 136,604 665 Patients ( 99.13% ) ( 78.24%) Number of Hepatitis 851 122 Monoinfected Patients ( 0.62% ) ( 14.35% ) Number of HIV 278 32 Monoinfected Patients ( 0.20%) ( 3.76%) Number of HIV and 68 31 Hepatitis Coinfected ( 0.05% ) ( 3.76% ) Patients Comorbidities Not Controlled For Controlled For Results Poorer Outcomes No Statistical Difference in Outcomes

  11. Summary & Conclusions In our two phase study, what originally appeared to be a difference in outcomes in HIV/Hepatitis patients disappeared when we controlled for major comorbidities.

Recommend


More recommend