Effects of pay for performance on risk incidence of infection and of revision after total knee arthroplasty in type 2 diabetic patients: A nationwide matched cohort study

• Published in: PloS one 2018-11, Vol.13 (11), p.e0206797-e0206797
• Main Authors: Tsai, Yi-Shiun, Kung, Pei-Tseng, Ku, Ming-Chou, Wang, Yeuh-Hsin, Tsai, Wen-Chen
• Format: Article
• Language: English
• Subjects: Aged; Arthritis; Arthroplasty (knee); Arthroplasty, Replacement, Knee - economics; Biology and Life Sciences; Biomedical materials; Cohort analysis; Comorbidity; Complications; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - economics; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - surgery; Engineering and Technology; Female; Hazards; Health insurance; Health risks; Humans; Incidence; Joint surgery; Knee; Male; Medicine and Health Sciences; Middle Aged; Patients; Pay for performance; People and Places; Postoperative Complications - economics; Postoperative Complications - epidemiology; Postoperative infection; Reimbursement, Incentive; Reoperation - economics; Retrospective Studies; Rheumatoid arthritis; Risk Factors; Socioeconomic Factors; Statistical analysis; Statistical models; Surgical implants; Systematic review; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0206797

As the world's population ages, the number of people receiving total knee arthroplasty (TKA) has been on the rise. Although patients with diabetes mellitus are known to face greater risks of TKA postoperative infection and revision TKA owing to diabetic complications, studies on whether such patients' participation in pay for performance (P4P) programs influences the incidence rates of TKA postoperative infection or revision TKA are still lacking. This study examined the 2002-2012 data of Taiwan's National Health Insurance Research Database to conduct a retrospective cohort analysis of diabetic patients over 50 years old who have received TKA. To reduce any selection bias between patients joining and not joining the P4P program, propensity score matching was applied. The Cox proportional hazards model was used to examine the influence of the P4P program on TKA postoperative infection and revision TKA, and the results indicate that joining P4P lowered the risk of postoperative infection (HR = 0.91, 95% CI: 0.77-1.08), however, which was not statistically significant, and significantly lowered the risk of revision TKA (HR = 0.53, 95% CI: 0.39-0.72). Being younger and male, having multiple comorbid conditions or greater diabetic severity, receiving care at regional or public hospitals, and not having a diagnosis of degenerative or rheumatoid arthritis were identified as factors for higher risk of TKA postoperative infection for patients with diabetes. As for the risk of revision TKA, postoperative infection and being younger were identified as factors for a significantly higher risk (p < 0.05).