Preoperative Risk Stratification Reduces the Incidence of Perioperative Complications After Total Knee Arthroplasty

2012 ◽  
Vol 27 (8) ◽  
pp. 77-80.e8 ◽  
Author(s):  
Kristen E. Radcliff ◽  
Fabio R. Orozco ◽  
Daniel Quinones ◽  
Daniel Rhoades ◽  
Gursukhman S. Sidhu ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Stratification ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Preoperative Risk ◽  
Total Knee ◽  
Preoperative Risk Stratification

Preoperative risk stratification minimizes 90-day complications in morbidly obese patients undergoing primary total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 45-50
Author(s):  
Yehuda E. Kerbel ◽  
Mitchell A. Johnson ◽  
Stephen R. Barchick ◽  
Jordan S. Cohen ◽  
Kimberly Lola Stevenson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Stratification ◽  
Knee Arthroplasty ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Preoperative Risk ◽  
Rehabilitation Facility ◽  
Significant Difference ◽  
Total Knee ◽  
Preoperative Risk Stratification

Aims It has been shown that the preoperative modification of risk factors associated with obesity may reduce complications after total knee arthroplasty (TKA). However, the optimal method of doing so remains unclear. The aim of this study was to investigate whether a preoperative Risk Stratification Tool (RST) devised in our institution could reduce unexpected intensive care unit (ICU) transfers and 90-day emergency department (ED) visits, readmissions, and reoperations after TKA in obese patients. Methods We retrospectively reviewed 1,614 consecutive patients undergoing primary unilateral TKA. Their mean age was 65.1 years (17.9 to 87.7) and the mean BMI was 34.2 kg/m2 (SD 7.7). All patients underwent perioperative optimization and monitoring using the RST, which is a validated calculation tool that provides a recommendation for postoperative ICU care or increased nursing support. Patients were divided into three groups: non-obese (BMI < 30 kg/m2, n = 512); obese (BMI 30 kg/m2 to 39.9 kg/m2, n = 748); and morbidly obese (BMI > 40 kg/m2, n = 354). Logistic regression analysis was used to evaluate the outcomes among the groups adjusted for age, sex, smoking, and diabetes. Results Obese patients had a significantly increased rate of discharge to a rehabilitation facility compared with non-obese patients (38.7% (426/1,102) vs 26.0% (133/512), respectively; p < 0.001). When stratified by BMI, discharge to a rehabilitation facility remained significantly higher compared with non-obese (26.0% (133)) in both obese (34.2% (256), odds ratio (OR) 1.6) and morbidly obese (48.0% (170), OR 3.1) patients (p < 0.001). However, there was no significant difference in unexpected ICU transfer (0.4% (two) non-obese vs 0.9% (seven) obese (OR 2.5) vs 1.7% (six) morbidly obese (OR 5.4); p = 0.054), visits to the ED (8.6% (44) vs 10.3% (77) (OR 1.3) vs 10.5% (37) (OR 1.2); p = 0.379), readmissions (4.5% (23) vs 4.0% (30) (OR 1.0) vs 5.1% (18) (OR 1.4); p = 0.322), or reoperations (2.5% (13) vs 3.3% (25) (OR 1.2) vs 3.1% (11) (OR 0.9); p = 0.939). Conclusion With the use of a preoperative RST, morbidly obese patients had similar rates of short-term postoperative adverse outcomes after primary TKA as non-obese patients. This supports the assertion that morbidly obese patients can safely undergo TKA with appropriate perioperative optimization and monitoring. Cite this article: Bone Joint J 2021;103-B(6 Supple A):45–50.

What are the Short-Term Outcomes in Multiple Sclerosis Patients after Total Knee Arthroplasty?

2018 ◽  
Vol 32 (02) ◽  
pp. 165-170 ◽  
Author(s):  
Jared Newman ◽  
Assem Sultan ◽  
Anton Khlopas ◽  
Nipun Sodhi ◽  
Mhamad Faour ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Primary Total Knee Arthroplasty ◽  
Care Facility ◽  
Medical Complication ◽  
Short Term ◽  
Total Knee ◽  
Multiple Sclerosis Patients

Due to the paucity of evidence, this study was conducted to evaluate: (1) unique characteristics of multiple sclerosis (MS) patients and (2) short-term clinical outcomes, of primary total knee arthroplasty (TKA) in patients with MS (MS-TKA) compared with matched non-MS patients. MS patients who underwent TKA were identified using the Nationwide Inpatient Sample (NIS) database. The study sample consisted of 10,884 patients with MS and 56,45,227 control cohort. Various patient factors were compared. To control for potential confounders, with the use of propensity scores, MS-TKA patients were matched (1:3) to non-MS-TKA patients and regression analyses were performed to compare perioperative complications, length of stay (LOS), and discharge dispositions. Patients with MS were younger, more likely to be females, on corticosteroids, and more likely to have muscle spasms and gait abnormalities. Annual frequency of TKAs in MS patients increased from 1.16/1,000 TKAs in 2002 to 2.48/1,000 TKAs in 2013 (p < 0.001). Compared with the matched cohort, MS patients had significantly greater odds for any medical complication (odds ratio [OR] = 1.26; 95% confidence interval [CI], 1.11–1.44), longer mean LOS (mean difference: 0.15; 95% CI, 0.09–0.22), and had a greater chance of being discharged to a care facility (OR = 2.17; 95% CI, 1.96–2.40). In this study, we identified specific characteristics of patients with MS who had TKA and analyzed and compared their short-term TKA outcomes to non-MS patients. It was demonstrated that more patients with MS are undergoing TKA, and these patients were at a higher risk of perioperative complications, had longer LOS, and were more likely to be discharged to a sub-acute or inpatient facility. Orthopaedic surgeons should be cognizant of the increased risks and provide proper counseling to MS patients who are candidates for TKA.

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements

2018 ◽  
Vol 32 (06) ◽  
pp. 475-482 ◽  
Author(s):  
Karim G. Sabeh ◽  
Samuel Rosas ◽  
Leonard T. Buller ◽  
Andrew A. Freiberg ◽  
Cynthia L. Emory ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Primary Total Knee Arthroplasty ◽  
Cost Of Care ◽  
Chronic Obstructive ◽  
Level Of Evidence ◽  
Medical Comorbidities ◽  
Total Knee ◽  
The Impact

AbstractMedical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294–26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost.

scholarly journals P1788 Prognostic value of stress echocardiography in preoperative risk stratification and management

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
I Almeida ◽  
R Pereira ◽  
I Cruz ◽  
M Quadrado ◽  
A R Almeida ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Stratification ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Perioperative Complications ◽  
Pharmacologic Stress ◽  
Cardiac Complications ◽  
Pharmacological Stress ◽  
Preoperative Risk ◽  
Preoperative Risk Stratification

Abstract Introduction The prognostic value of pharmacologic stress echocardiography has been extensively demonstrated in patients undergoing noncardiac surgery since 42% of the perioperative complications are cardiac. Coronary artery stenoses can became flow-limiting due to hemodynamic fluctuations in this period leading to myocardial ischemia. Purpose Evaluation of prognostic value of pharmacologic stress echocardiography in preoperative risk stratification. Methods Single center retrospective analysis of patients’ data referred to perform a preoperative risk stratification through pharmacological stress echocardiography between January 2014- December 2018. Data was collected regarding clinical and echocardiographic parameters to predict perioperative cardiac complications (myocardial infarction and development of arrythmias) and evaluate the impact of the result of DSE in patients´ clinical management. Results Of 910 pharmacological stress echocardiograms, 106 were performed to evaluate preoperative risk. Patients´ mean age was 66 ± 11 years, 85% males. 64% had hypertension, 45% dyslipidaemia, 38% current smokers and 18% diabetes. 189% had previously myocardial infarction and 9% stroke. All patients were proposed to intermediate-high risk surgeries: 73% to vascular surgery, 14% to kidney transplant and 13% to other type of surgery (especially abdominal surgery). Most of the stress tests (64%) were performed with dobutamine and the others 34% with dipyridamole. 91% of stress echocardiography were negative, 6% positive and 4% inconclusive. The patients with a positive stress test was submitted to coronary angiography to treat relevant lesions and cardiovascular risk factors were optimized. 72% of the patients has already been submitted to the proposed surgery; in this population, there was a 5% rate of cardiac complications following the surgery, all in patients with previous negative stress echocardiography. Complications were non-ST elevation myocardial infarction in 1% and de novo atrial fibrillation in 4%. Half of the patients with a positive stress echocardiography were operated with no cardiac perioperative complications, possibly related to patient´s optimization before the surgery; in the other half it was decided not to perform the surgery due to the potential cardiac risk. Predictor factors for perioperative cardiac complications, evaluated through univariate and multivariate analysis, were age (odds ratios (OR) 1.232, confidence interval (CI) 1.043-1.456, p 0.007) and stroke (OR 0.057, CI 0.947-44.592, p 0.033). Conclusion In our study, patients with a positive stress echocardiography were optimized before the surgery leading to none cardiac perioperative complications, emphasizing the importance of this test in preoperative patients´ management.

scholarly journals Perioperative complications following preoperative cessation of antithrombotic agents for total knee arthroplasty

Medicine ◽  
2016 ◽  
Vol 95 (48) ◽  
pp. e5487 ◽  
Author(s):  
Jin-Young Hwang ◽  
Sohee Oh ◽  
Chong-Soo Kim ◽  
Jee-Eun Chang ◽  
Seong-Won Min
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Antithrombotic Agents ◽  
Total Knee

Outpatient Total Knee Arthroplasty Is Associated with Higher Risk of Perioperative Complications

2017 ◽  
Vol 99 (23) ◽  
pp. 1978-1986 ◽  
Author(s):  
Armin Arshi ◽  
Natalie L. Leong ◽  
Anthony D’Oro ◽  
Christopher Wang ◽  
Zorica Buser ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Perioperative Complications ◽  
Total Knee

Mechanical Thromboembolic Prophylaxis With Risk Stratification in Total Knee Arthroplasty

2015 ◽  
Vol 30 (1) ◽  
pp. 43-45 ◽  
Author(s):  
William G. Hamilton ◽  
James D. Reeves ◽  
Kevin B. Fricka ◽  
Nitin Goyal ◽  
Gerard A. Engh ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Stratification ◽  
Knee Arthroplasty ◽  
Thromboembolic Prophylaxis ◽  
Total Knee

scholarly journals Incidence and Risk Factors of Postoperative Delirium Following Total Knee Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study

2020 ◽  
Author(s):  
Jian Wang ◽  
Qinfeng Yang ◽  
Yichuan Xu ◽  
Yuhang Chen ◽  
Qiang Lian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Total Knee Arthroplasty ◽  
Hospital Mortality ◽  
Knee Arthroplasty ◽  
Nationwide Inpatient Sample ◽  
Postoperative Delirium ◽  
Perioperative Complications ◽  
Total Knee ◽  
Total Charges

Abstract BackgroundPostoperative delirium is a common complication following major surgeries, causing a variety of adverse effects. However, the incidence and risk factors of delirium after total knee arthroplasty (TKA) has not been well studied using a large-scale national database. MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005-2014. Patients who underwent TKA were included. Patient demographics, comorbidities, length of stay (LOS), total charges, type of insurance, in-hospital mortality, and medical and surgical perioperative complications were evaluated.ResultsA total of 1,228,879 TKAs were obtained from the NIS database. The general incidence of delirium after TKA was 1.00%, which peaked in the year 2008. Patients with delirium after TKA presented more comorbidities, increased LOS, extra hospital charges, wider coverage of medicare, and higher in-hospital mortality (P<0.0001). Delirium following TKA was associated with medical complications during hospitalization including acute renal failure, acute myocardial infarction, pneumonia, pulmonary embolism, stroke, and urinary tract infection. Risk factors of postoperative delirium included advanced age, neurological disorders, alcohol and drug abuse, depression, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency and chronic blood loss anemia, coagulopathy, congestive heart failure, chronic pulmonary disease and pulmonary circulation disorders, peripheral vascular disorders, renal failure, and teaching hospital. ConclusionsA relatively low incidence of delirium after TKA was identified. Postoperative delirium of TKA was associated with increased comorbidities, LOS, total charges, coverage of medicare, mortality and medical perioperative complications. It is of benefit to study risk factors of postoperative delirium to ensure the appropriate management and moderate its consequences.

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