Joint Replacement in Veterans: Are Risks and Outcomes Different by Gender

Budiman-Mak E, Weaver FM, Hynes D, Ippolito D, Thakkar B, Gibbs J, Wixson R, Hopkins W, Khuri S, Daley J, Henderson W. Joint Replacement in Veterans: Are Risks and Outcomes Different by Gender. Paper presented at: American College of Rheumatology / Association of Rheumatology Health Professionals Annual Meeting; 2000 Oct 29; Philadelphia, PA.

Purpose: To study the differences of sociodemographics, pre-operative risks and clinical of total hip and knee replacement (THR and TKR) between male and female veterans. The outcomes include differences in pre-operative demographics, functional status, medical and behavioral risks, and post-operative mortality, morbidity and readmission. Method: Secondary analysis of the VA National Surgical Quality Improvement Program (NSQIP) database, consisting a cohort of 9,200 THR and 12,101 TKR (FY 91-FY 97) and readmission data within one year from VA Patient Treatment File. Descriptive statistics, multiple and logistic regression analyses were applied to obtain outcomes. Results: THR performed in 8,928 males and 272 females, majority was white. Compared to females, male were younger and married (p's < 0.01), and more frequent smokers and alcohol users (p's < 0.003). Females had worse functional impairment and higher co-morbidities (p's < 0.017). We found no gender differences 30-day mortality, morbidity, and readmission, within one year. TKR were performed in 11,711 males, and 390 females. Females were younger (p < 0.02) and had higher 30-day morbidity rate. The most common primary diagnoses at THR were osteoarthritis (OA) (male 52%, female 43%), aseptic necrosis (male 11.5%, female 7%), and fracture femur: (male 23%, female 31%); at TKR, were OA (male 86.4%, female 85.4%) and rheumatoid arthritis (male 2.4%, female 4.6%). Conclusion: In THR, gender did not determine outcomes, but in TKR females had higher morbidity rate within 30-days. Gender was related to preoperative-risks and primary diagnoses at surgery.