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Gout is associated with increased healthcare utilization after knee arthroplasty
  1. Jasvinder A Singh1,2,3,
  2. John David Cleveland2
  1. 1 Medicine Service, VA Medical Center, Birmingham, Alabama, USA
  2. 2 Department of Medicine at School of Medicine, University of Alabama, Birmingham, Alabama, USA
  3. 3 Division of Epidemiology at School of Public Health, University of Alabama, Birmingham, Alabama, USA
  1. Correspondence to Dr Jasvinder A Singh, Department of Medicine at School of Medicine, University of Alabama, Birmingham, AL 35294-0022, USA;{at}

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Total knee arthroplasty (TKA) is an effective surgery for patients with advanced knee arthritis refractory to medical treatment. Gout, the most common inflammatory arthritis in adults, was associated with a 40% increased TKA risk in women in a recent population-based study.1 This was attributable possibly to accelerated cartilage wear associated with soluble urate or urate crystals. It is not known if post-TKA healthcare utilisation and complications are higher in people with gout. We assessed whether gout was associated with a higher risk of post-TKA healthcare utilisation and in-hospital complications.

We used the 1998–2014 US National Inpatient Sample data, a 20% stratified sample of discharges from US community hospitals.2 We used validated International Classification of Disease, ninth revision, common modification (ICD-9-CM) code to identify the primary TKA cohort (81.54)3, with TKA as the primary procedure and among these people with and without gout (274).4 Study outcomes post-primary TKA were (1) healthcare utilisation, length of hospital stay (>3 days) and the discharge disposition, that is, to home versus rehabilitation/in-patient facility; and (2) in-hospital postoperative complications identified by respective ICD-9-CM codes for transfusion, revision or infection, …

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  • Handling editor Josef S Smolen

  • Contributors Study concept and design: JAS. Data acquisition, analysis and interpretation of results: JAS, JDC. Drafting of the manuscript: JAS. Critical revision of the manuscript for important intellectual content: JAS, JDC. Statistical analysis: JDC. Obtained funding: JAS. Administrative, technical or material support: JAS. Study supervision: JAS.

  • Funding This material is the result of work supported by research funds from the Division of Rheumatology at the University of Alabama at Birmingham and the resources and use of facilities at the Birmingham VA Medical Center, Birmingham, Alabama, USA.

  • Disclaimer The funding body did not play any role in design; in the collection, analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.

  • Competing interests JAS has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, Merz, Iroko, Bioiberica, Crealta/Horizon and Allergan Pharmaceuticals, WebMD, UBM LLC and the American College of Rheumatology.JAS owns stock options in Amarin pharmaceuticals and Viking therapeutics. JAS serves as the principal investigator for an investigator-initiated study funded by Horizon Pharmaceuticals through a grant to DINORA, Inc., a 501(c)(3) entity. JAS is a member of the executive of OMERACT, an organisation that develops outcome measures in rheumatology and receives arms-length funding from 36 companies; a member of the American College of Rheumatology’s (ACR) Annual Meeting Planning Committee (AMPC); Chair of the ACR Meet-the-Professor, Workshop and Study Group Subcommittee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. JAS is the editor and Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis. JDC has no conflicts to declare. There are no non-financial competing interests for any of the authors.

  • Patient consent for publication Not required.

  • Ethics approval The University of Alabama at Birmingham’s Institutional Review Board approved this study and waived the need for informed consent for this database study. All investigations were conducted in conformity with ethical principles of research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement NIS are freely available to anyone who requests the data and signs the required confidentiality and privacy documents.

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