Association of preoperative anemia and increased risk of blood transfusion and length of hospital stay in adults undergoing hip and knee arthroplasty: An observational study in a single tertiary center

Abstract Introduction Persistent wound ooze has been associated with prolonged length of hospital stay and increased risk of infection. Recently, the use of tissue adhesive after hip and knee arthroplasty has been described. We believe that knee arthroplasty wounds exhibit different behavior compared to hip arthroplasty due to the increased wound-margin tension associated with knee flexion. Patients and methods Forty-three patients undergoing total knee arthroplasty (TKA) by a single surgeon were studied. All wounds were closed using staples with or without tissue adhesive. Post-operatively, the wounds were reviewed daily for ooze. Dressings were changed only if soaked > 50% or if there was persistent wound discharge of more than 2 × 2 cm at 72 h. Results There were 21 patients in the tissue adhesive (group 1), 22 in the non-tissue adhesive (group 2) with the average age for group 1 of 72.2 years and for group 2 of 69.3 years. The median length of stay for both groups was 4 days (range of 3–7 days for group 1 and 2–6 days for group 2) (P = 0.960). The tissue adhesive group showed a statistically significant reduction in wound ooze on day 1 (P = 0.019); however, the difference was not significant on the following days. The median for the number of dressing changes for group 1 was zero changes and for group 2, one change. This was not statistically significant (P = 0.112). No complications were observed in both groups and there were no reactions to the tissue adhesive. Conclusion The data from this case series suggest that the use of tissue adhesive may reduce wound ooze on day 1 only. The latter is most likely due to significant tensile forces to which the knee arthroplasty wound is subjected in the immediate post-operative rehabilitation. Further, the cost of tissue adhesive is not offset by reduced dressing changes or length of hospital stay.

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Vancouver B periprosthetic fractures involving the Exeter cemented stem

The Bone & Joint Journal ◽

10.1302/0301-620x.103b2.bjj-2020-0695.r1 ◽

2021 ◽

Vol 103-B (2) ◽

pp. 309-320

Author(s):

Matilda F. R. Powell-Bowns ◽

Erlend Oag ◽

Nathan Ng ◽

Hemant Pandit ◽

Matthew Moran ◽

...

Keyword(s):

Blood Transfusion ◽

Hospital Stay ◽

Bone Cement ◽

Revision Arthroplasty ◽

Femoral Stem ◽

Length Of Hospital Stay ◽

Primary Outcome Measure ◽

Cement Interface ◽

Kaplan Meier ◽

Increased Risk

Aims The aim of this study was to determine whether fixation, as opposed to revision arthroplasty, can be safely used to treat reducible Vancouver B type fractures in association with a cemented collarless polished tapered femoral stem (the Exeter). Methods This retrospective cohort study assessed 152 operatively managed consecutive unilateral Vancouver B fractures involving Exeter stems; 130 were managed with open reduction and internal fixation (ORIF) and 22 with revision arthroplasty. Mean follow-up was 6.5 years (SD 2.6; 3.2 to 12.1). The primary outcome measure was revision of at least one component. Kaplan–Meier survival analysis was performed. Regression analysis was used to identify risk factors for revision following ORIF. Secondary outcomes included any reoperation, complications, blood transfusion, length of hospital stay, and mortality. Results Fractures (B1 n = 74 (49%); B2 n = 50 (33%); and B3 n = 28 (18%)) occurred at median of 4.2 years (interquartile range (IQR) 1.2 to 9.2) after primary total hip arthroplasty (THA) (n = 138) or hemiarthroplasty (n = 14). Rates of revision and reoperation were significantly higher following revision arthroplasty compared to ORIF for B2 (p = 0.001) and B3 fractures (p = 0.050). Five-year survival was significantly better following ORIF: 92% (95% confidence interval (CI) 86.4% to 97.4%) versus 63% (95% CI 41.7% to 83.3%), p < 0.001. ORIF was associated with reduced blood transfusion requirement and reoperations, but there were no differences in medical complications, hospital stay, or mortality between surgical groups. No independent predictors of revision following ORIF were identified: where the bone-cement interface was intact, fixation of B2 or B3 fractures was not associated with an increased risk of revision. Conclusion When the bone-cement interface was intact and the fracture was anatomically reducible, all Vancouver B fractures around Exeter stems could be managed with fixation as opposed to revision arthroplasty. Fixation was associated with reduced need for blood transfusion and lower risk of revision surgery compared with revision arthroplasty. Cite this article: Bone Joint J 2021;103-B(2):309–320.

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Weekend Arthroplasty: A Longer Inpatient Stay?

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363512x1331131419546 ◽

2012 ◽

Vol 94 (6) ◽

pp. 208-210 ◽

Cited By ~ 3

Author(s):

D Gibbs ◽

S Tafazal ◽

R Handley ◽

M Newey

Keyword(s):

Hospital Stay ◽

Knee Arthroplasty ◽

Orthopaedic Surgery ◽

Length Of Hospital Stay ◽

Published Data ◽

Inpatient Stay ◽

Hip And Knee Arthroplasty ◽

Knee Arthroplasty Surgery ◽

Arthroplasty Surgery

As pressures mount on efficiency, hip and knee arthroplasty surgery is increasingly being performed during weekends. Despite the growing trend for weekend orthopaedic surgery, there are virtually no published data on the effect of weekend operating on the length of hospital stay (LOS).

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The impact of the COVID-19 pandemic on the length of stay following total hip and knee arthroplasty in a high volume elective orthopaedic unit

Bone & Joint Open ◽

10.1302/2633-1462.28.bjo-2021-0022.r1 ◽

2021 ◽

Vol 2 (8) ◽

pp. 655-660

Author(s):

Gemma Green ◽

Sarah Abbott ◽

Yiannis Vyrides ◽

Irrum Afzal ◽

Deiary Kader ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Demographic Data ◽

Length Of Hospital Stay ◽

High Volume ◽

Postoperative Rehabilitation ◽

Time To Surgery ◽

Hip And Knee Arthroplasty ◽

The Impact

Aims Elective orthopaedic services have had to adapt to significant system-wide pressures since the emergence of COVID-19 in December 2019. Length of stay is often recognized as a key marker of quality of care in patients undergoing arthroplasty. Expeditious discharge is key in establishing early rehabilitation and in reducing infection risk, both procedure-related and from COVID-19. The primary aim was to determine the effects of the COVID-19 pandemic length of stay following hip and knee arthroplasty at a high-volume, elective orthopaedic centre. Methods A retrospective cohort study was performed. Patients undergoing primary or revision hip or knee arthroplasty over a six-month period, from 1 July to 31 December 2020, were compared to the same period in 2019 before the COVID-19 pandemic. Demographic data, American Society of Anesthesiologists (ASA) grade, wait to surgery, COVID-19 status, and length of hospital stay were recorded. Results A total of 1,311 patients underwent hip or knee arthroplasty in the six-month period following recommencement of elective services in 2020 compared to 1,527 patients the year before. Waiting time to surgery increased in post-COVID-19 group (137 days vs 78; p < 0.001). Length of stay also significantly increased (0.49 days; p < 0.001) despite no difference in age or ASA grade. There were no cases of postoperative COVID-19 infection. Conclusion Time to surgery and length of hospital stay were significantly higher following recommencement of elective orthopaedic services in the latter part of 2020 in comparison to a similar patient cohort from the year before. Longer waiting times may have contributed to the clinical and radiological deterioration of arthritis and general musculoskeletal conditioning, which may in turn have affected immediate postoperative rehabilitation and mobilization, as well as increasing hospital stay. Cite this article: Bone Jt Open 2021;2(8):655–660.

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Enhanced Recovery After Surgery in elective hip and knee arthroplasty reduces length of hospital stay

ANZ Journal of Surgery ◽

10.1111/ans.13538 ◽

2016 ◽

Vol 86 (6) ◽

pp. 475-479 ◽

Cited By ~ 50

Author(s):

Marinus D. J. Stowers ◽

Lavell Manuopangai ◽

Andrew G. Hill ◽

Jonathon R. Gray ◽

Brendan Coleman ◽

...

Keyword(s):

Hospital Stay ◽

Knee Arthroplasty ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Length Of Hospital Stay ◽

Hip And Knee Arthroplasty

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Does Not Use of Closed Suction Drainage in Total Knee Arthroplasty with Tranexamic Acid Reduce Blood Loss?

Ortopedia Traumatologia Rehabilitacja ◽

10.5604/01.3001.0014.4224 ◽

2020 ◽

Vol 22 (5) ◽

pp. 343-352

Author(s):

Naci Ruşen Senih Ayan ◽

Yavuz Akalın ◽

Nazan Çevik ◽

Harun Sağlıcak ◽

Burak Olcay Güler ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Hospital Stay ◽

Knee Arthroplasty ◽

Length Of Hospital Stay ◽

Total Knee ◽

Group 2 ◽

Group 1

Background. The aim of this study was to compare outcomes in patients who received intravenous tranexamic acid just before and after total knee arthroplasty with or without drains and to analyze whether there is any difference in terms of blood loss. Material and methods. This is a retrospective analysis of prospectively collected data of patients undergoing unilateral total knee arthroplasty. Between March 2017 and March 2019, 97 knees of 94 consecutive patients with osteoarthritis were divided into two groups (Group 1, with drain; and 2, without drain). Drainage group (53 knees; average age, 66,1±7,0 years; male, 10; female, 43) and a drainless group (44 knees; average age, 63,7± 7,5 years; male, 4; female, 40). All patients received systemic tranexamic acid (in 100 mL saline infusion iv in 30 minutes prior to the tourniquet inflation and 3 hours after the operation). Blood loss, allogeneic blood transfusion rates, complications such as swelling of the cruris, infection (deep or superficial), thromboembolic incidents (Deep venous thrombosis or pulmoner thromboembolism) and length of hospital stay were assessed postoperatively. Results. There was no difference in demographic parameters, body mass index, side ofsurgery, ASA score and anesthesia type between 2 groups. The preoperative Hb levels were comparable but on the postoperative day one, Hb level was lower in the drain group (p=0,017). Total blood loss (TBL) and allogeneic transfusion rates were lower in the drainless group, although did not differ signiﬁcantly between the two groups [TBL: 1360,9±502,5 / 646,1-2641,6 (1251,6) mL in the Group 1, 1205,6±505,0 / 396,6-2521,0 (1157,5) mL in Group 2 (p=0,134); Transfusion rates: 11 out of 53 cases (%20,8) in group 1 and 5 out of 44 cases (%11,4) in group 2]. The infection rate and length of hospital stay were lower in the drainless group. But there were no statistical difference was found in terms of complications and length of hospital stay between 2 groups. Conclusions. 1. Performing Total Knee Arthroplasty with preoperative and postoperative ivtranexamic acid and without drain decreased postoperative reduction in Hb level on the day after surgery in the current study. 2. But blood loss and blood transfusion rates when compared to patients with drain, no significant difference was found. 3. Drain use in knee replacements does not offer an advantage over drainless TKAs regarding the findings of our study. 4. Future studies with longer follow-up are needed in our opinion.

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