Gout Linked to Increased Healthcare Use After Total Knee Arthroplasty

Digital x-ray following successful knee replacement surgery
Gout was associated with a statistically significant higher risk for discharge to a nonhome setting, length of hospital stay above 3 days, and need for transfusion.

Gout is associated with increased healthcare use and in-hospital complications following total knee arthroplasty (TKA), according to the results of a cohort study published in Annals of the Rheumatic Diseases.

Researchers used data from the 1998 to 2014 US National Inpatient Sample. Study outcomes following primary TKA included healthcare utilization, length of hospital stay (>3 days), and discharge disposition (discharge to home vs rehabilitation facility), and in-hospital postsurgical complications, which were identified using ICD-9-CM codes for transfusion, revision or infection, and in-hospital mortality. Separate multivariable-adjusted logistic analyses were used to control for covariates and potential confounders, including gender, age, race, and underlying primary diagnosis for TKA. Furthermore, sensitivity analyses adjusted for hospital location and teaching status, hospital bed size, and hospital region.

Of the 8,127,182 primary TKAs performed from 1998 to 2014, a total of 231,470 of the surgeries were carried out among patients with gout. Compared with individuals without gout, patients with gout were significantly older, were more likely to be men, black, have a larger number of medical comorbidities, and to have a low income.

Related Articles

Following multivariable adjustment, the presence of gout was associated with statistically significant higher findings for discharge to a nonhome setting such as a rehabilitation or in-patient facility (odds ratio [OR], 1.18; 95% CI, 1.15-1.20), length of hospital stay of >3 days (OR, 1.08; 95% CI, 1.06-1.10), and transfusion (OR, 1.15; 95% CI, 1.12-1.18). No statistically significant differences were observed with respect to infection or revision. Additionally, mortality was lower among the patients with gout vs those without gout (OR, 0.51; 95% CI, 0.36-0.72).

Based on the results of this study, gout was independently associated with an 18%, 8%, and 15% higher risk for discharge to a nonhome setting, length of hospital stay >3 days, and need for in-hospital transfusion, respectively, following TKA. Study findings were limited, however, because of residual confounding bias and the lack of available longitudinal data.

The investigators concluded that additional studies are warranted to determine whether improved management of gout can reduce the increased healthcare utilization and risk for transfusion following TKA surgery.


Singh JA, Cleveland JD. Gout is associated with increased healthcare utilization after knee arthroplasty [published online February 2, 2019]. Ann Rheum Dis. doi: 10.1136/annrheumdis-2018-214934