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2005 National Healthcare Quality Report

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Adverse events associated with knee joint replacement

Measure Source

Centers for Medicare & Medicaid Services (CMS), Medicare Patient Safety Monitoring System (MPSMS).


2.37 Percent of patients who had a knee joint replacement with adverse events associated with the knee joint replacement, United States, 2002 and 2003.

Data Source

  1. CMS, MPSMS, inpatient medical records: for abstracted data related to the index hospital stay.
  2. CMS Medicare Administrative Data: used for 30-day post-procedure mortality, and to determine 30-day post-procedure readmission.


All patients in the MPSMS sample who experienced a surgical procedure performed to replace an arthritic or damaged knee joint.


Subset of the denominator who experienced at least 1 of the following:

  • Postoperative infection
  • Postoperative pneumonia
  • Postoperative urinary tract infection
  • Postoperative venous thromboembolic event meeting either of the following criteria:
  • During the hospital stay (per abstracted information from medical records)
  • Readmission to the hospital post-index hospital stay for a PE or DVT within 30 days of the surgical procedure (per Medicare administrative data ICD-9-CM diagnosis codes 415.11, 415.19, 451.1, 451.2, 451.81, 451.83, 451.84, 451.89, 453.1, 453.2, 453.8, 453.9)
  • Dislocation
  • Wound complication other than infection
  • Nerve injury
  • Postoperative bleeding requiring 4 or more blood transfusions
  • Cardiovascular complications
  • Same side revision during the index hospital stay
  • Return to operating room for reasons other than same side revision during the index hospital stay
  • Periprosthetic fracture (only applies to 2003 data)


Postoperative infections are determined by documentation of early prosthetic joint and/or wound infection and acute and early deep hip infection, excluding superficial infection.

Postoperative pneumonia, postoperative urinary tract infection, postoperative deep vein thrombosis and pulmonary embolus are all determined in the same fashion as those in other MPSMS measures.

The definition of major bleeding/hematoma underwent revision between 2002 and 2003.

Cardiovascular complications include myocardial infarction, congestive heart failure, and arrhythmia requiring treatment.

Wound complications other than infection include dehiscence, hematoma, and necrosis.

In order to attain greater consistency between 2002 and 2003 data, the analytic approach used to produce these tables differs from earlier years of the NHQR.

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Percent of community-dwelling elderly who had at least 1 prescription (from a list of 11 medications and from a list of 33 medications) that is potentially inappropriate for the elderly. Adverse events associated with hip joint replacement due to fracture or degenerative conditions.



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