Adverse Outcomes Associated with Beers List Medications Following Total Knee Replacement Public

Abstract

Background: Total knee replacement surgery (TKA) is frequently conducted to relieve the symptoms of advanced arthritis of the joint in the past few decades. Although TKA is a highly successful procedure, it can still lead to adverse events, such as readmission, reoperation, emergency room (ER) visit, mortality, and longer length of stay in hospital. Besides other factors contributing to the complication, use of Beers drug could also be a contributor. Beers list is a list of medications that are potentially inappropriate for aged population. In 2015, American Geriatrics Society divided the Beers medications into three categories, Beers 0 (medications that should be used with caution), Beers 1 (medications that should be avoided in all older adults), and Beers 2 (medications that should be avoided in older adults with certain medical condition).

Objectives: In this study, we aim to characterize the usage of three Beers med- ications in TKA operations performed in the VA health system from 2010 to 2014. We also want to examine the association between the usage of Beers medication and the adverse events (readmission, reoperation, ER visit, mortality, and length of stay in hospital).

Methods: Statistical control chart was used to examine the trend of the three Beers medications over the years. For binary complications (readmission, reoperation, ER visit and mortality), logistic regression was used to detect association with Beer drug dose count after controlling for other clinically interested covariates. The length of stay in hospital was analyzed using multiple linear regression.

Results: Beers 0 has a significant increasing trend in the usage over the 5-year study, while Beers 1 and 2 don’t. Beers 1 dose count is significantly associated with readmission within 30 days (OR= 1.03, p= 0.0415) and 90 days (OR= 1.02, p= 0.0409), as well as ER visit within 72h (OR= 1.05, p= 0.0159), within 7 days (OR= 1.04, p= 0.0013), and within 30 days (OR= 1.04, p< 0.001). Beers 2 dose count is significantly associated with ER visit within 72h (OR= 1.24, p= 0.0053), within 7 days (OR= 1.14, p= 0.0113), and within 30 days (OR= 1.09, p= 0.0286). The dose counts of the three Beers medications are associated with the length of stay, among which, Beers 0 has negative association with length of stay (estimate= -0.06, p= 0.0122), while Beers 1 and 2 have positive association (estimate= 0.04, p<0.001 and estimate= 0.14, p<0.001 for Beers 1 and 2 respectively).

Conclusion: The use of Beers 0 has an increasing trend over years while that of Beers 2 and 1 are fairly stable. Beers 1 increases the risk of readmission and ER visit. Beers 2 increases the risk of ER visits. All three categories can significantly contribute to the length of stay in hospital. One dose increase of Beers 0 leads to 1.53 hours shorter while one dose of Beers 1 and Beers 2 leads to 0.72 hour and 1.68 hours longer, respectively.

Table of Contents

1 Introduction 1

1.1 TotalKneeArthroplasties(TKA) .................... 1 1.2 BeersListDrug.............................. 2 1.3 AimofStudy ............................... 3

2 Method 4

2.1 Dataextraction.............................. 4 2.2 Datacleaningandfiltering........................ 5 2.3 Dataanalysis ............................... 6 2.4 Softwareinformation ........................... 7

3 Result 8

3.1 Studypopulation ............................. 8 3.2 Beersdrugusage ............................. 8 3.2.1 Generaldescription........................ 8 3.2.2 Dosecounttrendoveryears ................... 9 3.3 Lengthofstayinhospitalandcomplications . . . . . . . . . . . . . . 13 3.3.1 Relationship between length of stay in hospital and Beers drug dosecount............................. 14 3.3.2 Relationship between four complications and Beers drug dose count................................ 15

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4 Discussion 17 5 Appendix 20 Bibliography 21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Statistics Health Sciences, Surgery Health Sciences, Public Health
Mot-clé	Beers List Total knee replacement
Committee Chair / Thesis Advisor	Cui, Xiangqin, Emory University
Committee Members	Liu, Yuan, Emory University
Partnering Agencies	Hospital or other health care provider

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