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  • br Surgical complications were also similar for both

    2022-09-17


    Surgical complications were also similar for both groups with no difference reaching clinical significance (Table 3). Importantly, 90-day osteomyelitis and infection rates were similar for both groups.
    When assessing Medicare expenditure, we found no statistically significant difference in the 90-day period. THA in patients with a history of PCa was reimbursed at a mean of $14,153 compared to $14,033 for those without (P ¼ .114).
    Discussion
    The purpose of this Z-VAD-FMK study is to determine whether a history of PCa conferred increased risk of complications in patients following THA. We found that there was no increased rate of complications, length of stay, or Medicare reimbursements in these patients when compared to a matched control. Moreover, the finding of increased pneumonia in those without PCa history correlated with the increased use of postoperative intubation in that same cohort, likely explaining this difference [14].
    When we evaluated THA for breast cancer patients, the findings were similar in regard to complication rates [10]. Nonetheless, in this previous study, no distinction was made between statistically and clinically relevant differences, thus complicating the compar-ison. More importantly, a comparison of patients with a history of PCa to those with a history of breast cancer is not realistic as the myriad of cofounders that may affect such an analogy.
    Breast cancer and PCa are largely different diseases in regard to hormones, patient characteristics, disease progression, and mortality with disorganized cellular proliferation being the common factor [15,16]. Also, PCa is often labeled cured after surgical or medical treatment. It is then only selectively monitored, whereas breast cancer is often treated with long-duration chemotherapy before being deemed cured. This difference combined with the different treatment regimens, duration of therapy, and individual genetic characteristics between females and males makes a direct comparison cumbersome. However, the low incidence of complications in these 2 populations within 90 days of THA may provide surgeons guidance when consid-ering this population’s complications, costs, and counseling needs.
    Regarding the urinary complications, we chose not to further explore possible reasons as to why these may be greater in the no
    Table 1
    Characteristics of the Study Cohorts.
    Characteristics Percentage
    Age distribution
    CKD, chronic kidney disease; CLD, chronic liver disease; DM, diabetes mellitus.
    Table 2
    Ninety-Day Medical Complication Rate.
    Complication ICD/CPT Code No PCa
    PCa History Odds Ratio 95% CI P Value
    Rate
    Rate
    PCa, prostate cancer; ICD, International Classification of Disease; CPT, Current Procedural Terminology; CI, confidence interval. a Denotes a statistically significant difference representing a clinical difference.
    PCa cohort. It could be that patients with any complication occur-ring in the non-PCa group are recorded in the patient chart and treated as a complication of surgery, whereas in the PCa group all symptoms and/or complications are attributed to the patient’s PCa history, thus not seen as a new finding requiring treatment. Given that these patient charts are unavailable for evaluation, we cannot conclude as to why this difference occurred.
    This study used a large administrative database to assess the influence of PCa on complications and reimbursement following THA. In contrast, small samples of institutional databases are likely underpowered to detect a difference in complication rates among patients with only a history of cancer. A previous study pooled patients with different primary tumors in order to perform statis-tical analysis, which albeit valid due to the lack of data of this topic, may not fully allow for estimation of the PCa disease effects [17].The indolent nature of the PCa increases the likelihood of an arthro-plasty surgeon being involved in the care of a patient with a history of PCa. Therefore, understanding the relationship between PCa and THA outcomes becomes increasingly important. Furthermore, in the era of machine learning algorithms for patient-centric, co-morbidity, and risk factor specifically adjusted payment models, kidney stones is important to research which factors lead to increased economic expenditure. Our analysis of the 90-day reimbursements high-lighted the fact that past reimbursements of these patients have not been greater than their controls, providing reassurance to payers and clinicians alike, and that patients with a history of PCa should not be excluded from the THA candidate list.