Do in-hospital Rothman Index scores predict postdischarge adverse events and discharge location after total knee arthroplasty?

2021 ◽  
Author(s):  
Andrew D. Kleven ◽  
Austin H. Middleton ◽  
Ziynet Nesibe Kesimoglu ◽  
Isaac C. Slagel ◽  
Ashley E. Creager ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Discharge Location ◽  
Total Knee

scholarly journals Development, piloting, and evaluation of an evidence-based informed consent form for total knee arthroplasty (EvAb-Pilot): a protocol for a mixed methods study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Alina Weise ◽  
Julia Lühnen ◽  
Stefanie Bühn ◽  
Felicia Steffen ◽  
Sandro Zacher ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Informed Consent ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Legal Requirements ◽  
Consent Forms ◽  
Link Type ◽  
Total Knee

Abstract Background Practitioners frequently use informed consent forms to support the physician-patient communication and the informed consent process. Informed consent for surgery often focuses on risk centered information due to high liability risks for treatment errors. This may affect patients’ anxiety of adverse events and the nocebo effect. This study focuses on the optimization of pre-surgical information on risks and complications, and at the same time reconciles these information with legal requirements. Methods The development, piloting, and evaluation of evidence-based informed consent forms for total knee arthroplasty (TKA) and related anesthesia procedures will follow the UK MRC Framework for developing and evaluating complex interventions. Conducting different sub-studies, we will (I) qualitatively explore the information acquisition and decision-making processes, (II) develop and pilot test evidence-based informed consent forms on the example of TKA and related anesthesia procedures, (III) conduct a monocentric interrupted time series (ITS) pilot study to evaluate the effects of evidence-based informed consent forms in comparison with standard consent forms, and (IV) perform a process evaluation to identify barriers and facilitators to the implementation of the intervention and to analyze mechanisms of impact. Discussion The evidence-based and understandable presentation of risks in informed consent forms aims at avoiding distorted risk depiction and strengthening the patients’ competencies to correctly assess the risks of undergoing surgery. This might reduce negative expectations and anxiety of adverse events, which in turn might reduce the nocebo effect. At the same time, the practitioners’ acceptance of evidence-based informed consent forms meeting legal requirements could be increased. Trial registration ClinicalTrials.gov, NCT04669483. Registered 15 December 2020. German Clinical Trials Registry, DRKS00022571. Registered 15 December 2020

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

PERIOPERATIVE USE OF PREGABALIN IN TOTAL KNEE ARTHROPLASTY: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

2017 ◽  
Vol 20 (02) ◽  
pp. 1750009 ◽  
Author(s):  
Mohammed Tayyem ◽  
Fadi Elhadid ◽  
Ra’d Haddad ◽  
Omar Samarah ◽  
Mohammed Ananzah ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Randomized Controlled Trials ◽  
Pain Score ◽  
Knee Arthroplasty ◽  
P Value ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Pain Scores ◽  
Total Knee

Purpose: Pregabalin is a new neuropathic drug that gained recent popularity in treatment of acute postoperative pain. The purpose of this study is to study the effect of pregabalin in pain management in the first 24 h after total knee arthroplasty. Methods: PubMed, Scopus, EBSCO, and Web of science were searched for randomized controlled trials that study the effect of pregabalin in the management of pain after total knee arthroplasty. Pain scores at rest and with movement and opioid consumption in the first 24 h and the occurrence of adverse events were the primary outcome measure. The statistical software RevMan 5.3 was used to analyze the statistical significance of the results. Results: A total of 5 randomized controlled trials with 608 were collected. There was no significant benefit from the use of pregabalin in the management of pain in the perioperative period in patients undergoing primary total knee arthroplasty. Pain score after 24[Formula: see text]h at rest using 150 mg/day was (MD [Formula: see text]0.53, P value 0.23). Pain score after 24 h with movement using doses less than 300 mg/day was (MD [Formula: see text]1.11, P value 0.79). Opioid intake was not significantly reduced in patient taking pregabalin using doses less than 300 mg/day or doses higher than 300 mg/day (SMD [Formula: see text]0.42, 0.59. P value 0.10, 0.42, respectively). Most of studies observed increased occurrence of adverse events with the use of pregabalin. Conclusion: This study demonstrates that pregabalin does not decrease pain scores in the first 24 h after total knee arthroplasty while it increases the occurrence of side effects.

Adverse Events in Total Knee Arthroplasty: A National Medicare Study

2009 ◽  
Vol 24 (2) ◽  
pp. e6
Author(s):  
James Huddleston ◽  
William J. Maloney ◽  
Nancy Verzier ◽  
Yun Wang ◽  
David R. Hunt ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Total Knee

scholarly journals Rheumatoid Arthritis Does Not Increase Risk of Short-term Adverse Events after Total Knee Arthroplasty: A Retrospective Case-control Study

2015 ◽  
Vol 42 (7) ◽  
pp. 1123-1130 ◽  
Author(s):  
Zachary J. LoVerde ◽  
Lisa A. Mandl ◽  
Beverly K. Johnson ◽  
Mark P. Figgie ◽  
Friedrich Boettner ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
High Volume ◽  
Self Report ◽  
Surgical Volume ◽  
Superficial Infection ◽  
High Volume Center ◽  
Total Knee

Objective.More adverse events (AE) are reported after total knee arthroplasty (TKA) for patients with rheumatoid arthritis (RA) than for patients with osteoarthritis (OA). This study evaluates 6-month postoperative AE in a high-volume center in a contemporary RA cohort.Methods.Patients with RA in an institutional registry (2007–2010) were studied. AE were identified by self-report and review of office and hospital charts. Subjects with RA were matched to 2 with OA by age, sex, and procedure. RA-specific surgical volume was determined. Baseline characteristics and AE were compared and analyzed.Results.There were 159 RA TKA and 318 OA. Of the patients with RA, 88.0% were women, 24.5% received corticosteroids, 41.5% received biologics, and 67% received nonbiologic disease-modifying antirheumatic drugs (DMARD). There was no difference in comorbidities. RA-specific surgical volume was high; 64% of cases were performed by surgeons with ≥ 20 RA cases during the study period. Patients with RA had worse baseline pain and function and lower perceived health status (EQ-5D 0.59 vs 0.65, p < 0.01). There were no deep infections in either group and no difference in superficial infection (9.4% RA vs 10.1% OA, p = 0.82), myocardial infarction (0.7% RA vs 0% OA, p = 0.33), or thromboembolism (1.3% RA vs 0.6% OA, p = 0.60).Conclusion.In a high-volume center, with high RA-specific experience, RA does not increase postoperative AE. Despite worse preoperative function and high steroid and DMARD use, complications were not increased. However, further study to determine generalizability is needed.

scholarly journals Revision Total Knee Arthroplasty With the Use of Restricted Kinematic Alignment Protocol: Surgical Technique and Initial Results

2021 ◽  
Vol 8 ◽  
Author(s):  
Lazaros Kostretzis ◽  
Gabriel Bouchard Roby ◽  
Sagi Martinov ◽  
Marc-Olivier Kiss ◽  
Janie Barry ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Womac Score ◽  
Kinematic Alignment ◽  
Posterior Stabilized ◽  
Patient Reported ◽  
Total Knee ◽  
Revision Tka

Purpose: Kinematic alignment (KA) for primary total knee arthroplasty (TKA) has been shown to provide equivalent or better results to mechanical alignment (MA). The use of KA in revision TKA to restore the individual knee anatomy, kinematics, and soft-tissue balance, has not been documented yet. The purpose of this study is to describe the technique for performing TKA revision using the restricted KA (rKA) protocol and to report (1) rerevision rate and adverse events, (2) patient-reported outcome measures (PROMs), and (3) radiological signs of implant dysfunction related to this technique.Methods: The rKA protocol was used in 43 selected TKA revisions cases suitable for the technique. Adverse events, reoperation, revision, and their causes were recorded. In addition, PROMs assessed by WOMAC score and radiographic evaluation to identify signs of implant dysfunction were documented at last follow-up.Results: After a mean follow-up of 4.0 years (0.9–7.7, ±2), only one rerevision (2.3%) was required for persisting instability (polyethylene liner exchange from posterior stabilized to a semi-constrained). Short-cemented stems were used for both the femur and tibia in 28 (65%) cases, for the femur alone in 13 (30%) cases, and no stems in two cases. In 31 (72%) cases, a standard posterior stabilized tibial insert was used, while 12 (28%) cases required a semi-constrained insert. The mean WOMAC score was 34.4 (0–80, ±21.7). Mean postoperative arithmetic hip-knee-ankle angle (HKA) was 0.8° varus (from 5° varus to 4° valgus), mean mechanical distal femoral angle was 1.7° valgus (from 2° varus to 5° valgus), and mean mechanical tibia proximal angle was 2.2° varus (from 5° varus to 1° valgus). No radiological evidence of aseptic loosening or periprosthetic radiolucencies were identified.Conclusion: Although current revision TKA implants are not ideal for revision TKA performed with rKA, they are an appealing alternative to MA, especially in cases of early, non-wear-related, unsuccessful MA TKAs. rKA TKA revision using short-cemented stems in conjunction with meticulous preoperative planning is safe in the mid-term.Level of evidence: IV

scholarly journals Using Illness Rating Systems to Predict Discharge Location Following Total Knee Arthroplasty

2018 ◽  
Vol 30 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Sarah Rudasill ◽  
Jonathan R. Dattilo ◽  
Jiabin Liu ◽  
Ari Clements ◽  
Charles L. Nelson ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Rating Systems ◽  
Discharge Location ◽  
Total Knee

Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty

Orthopedics ◽  
2020 ◽  
Vol 43 (4) ◽  
pp. 233-238
Author(s):  
Rohil Malpani ◽  
Ryan P. Mclynn ◽  
Patawut Bovonratwet ◽  
Paul S. Bagi ◽  
Alp Yurter ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Factor ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Total Hip ◽  
Total Knee

Effect of Liposomal Bupivacaine on Postoperative Opioid Requirements for Total Hip Arthroplasty, Total Knee Arthroplasty, Laminectomy, Hysterectomy, and Abdominoplasty Procedures

2019 ◽  
pp. 001857871986764
Author(s):  
J. Lacie Bradford ◽  
Beatrice Turner ◽  
Megan A. Van Berkel
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Pain Control ◽  
Opioid Consumption ◽  
Control Group ◽  
Liposomal Bupivacaine ◽  
Pain Scores ◽  
Total Knee

Purpose: Opioid use postoperatively has been linked to adverse events and an increase in opioid dependency. This retrospective study evaluated the effect of using liposomal bupivacaine (LB) for postoperative pain control on total opioid consumption, pain control, serious opioid-related adverse events (ORAEs), and hospital length of stay (LOS) in total knee arthroplasty (TKA), total hip arthroplasty (THA), laminectomy, hysterectomy, and abdominoplasty procedures when compared with a control group. Methods: Patients receiving LB from August 1, 2017, to February 1, 2018, for the aforementioned procedures were included for evaluation, and patients undergoing similar procedures who did not receive LB served as the control group. The principal outcome was opioid consumption through postoperative day 5 or discharge, whichever came first, assessed by morphine milligram equivalents (MMEs). Secondary outcomes included pain scores within 72 hours postoperation, hospital LOS, and serious ORAEs. Results: A total of 323 patients were identified for inclusion in the study: TKA, n = 144; THA, n = 48; laminectomy, n = 73; hysterectomy, n = 30; and abdominoplasty, n = 28. Liposomal bupivacaine use was associated with reduced postoperative opioid consumption compared with alternative therapies with a median 71 MME (25%-75%; interquartile range [IQR] = 32.5-148.5) versus 102 MME (25%-75%; IQR = 57-165), P < .005. However, higher numeric pain scores were reported in the LB group compared with the control group for postoperative day 0 with a median of 5.5 (25%-75%; IQR = 4.5-7.4) versus 5.5 (25%-75%; IQR = 4-7) in the control group ( P < .001) and on postoperative day 1 with a median of 6 (25%-75%; IQR = 4.5-7) versus 5.5 (25%-75%; IQR = 4.3-7), P < .001. There was no difference in hospital LOS or ORAEs. Conclusion: In this retrospective analysis of pain management after TKA, THA, laminectomy, hysterectomy, and abdominoplasty procedures, patients receiving LB consumed significantly less opioid medications. However, this was not associated with clinically meaningful improvements in pain scores, hospital LOS, or serious ORAEs.

scholarly journals An opioid-sparing protocol with intravenous parecoxib can effectively reduce morphine consumption after simultaneous bilateral total knee arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hsuan-Hsiao Ma ◽  
Te-Feng Arthur Chou ◽  
Hsin-Yi Wang ◽  
Shang-Wen Tsai ◽  
Cheng-Fong Chen ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Pain Relief ◽  
Adverse Events ◽  
Knee Arthroplasty ◽  
Bilateral Total Knee Arthroplasty ◽  
Morphine Dose ◽  
Opioid Dose ◽  
Opioid Sparing ◽  
Total Knee

AbstractMultimodal pain management protocol effectively relieves pain following simultaneous bilateral total knee arthroplasty (SBTKA) but is associated with administration of large amounts of opioids in the perioperative period. In this prospective, randomized, assessor-blinded, single-surgeon clinical trial, the goal was to validate the efficacy of an opioid-sparing protocol for SBTKA with a reduced opioid dose, while achieving similar pain relief with few adverse events. Fifty-six patients who had undergone SBTKA were randomly allocated to receive either an opioid-sparing or opioid-based protocol. The primary outcome parameters were visual analogue scale (VAS) scores at rest, with movement, and cumulative morphine dose, through time. Secondary outcome parameters included drug-related adverse events and range of motion with continuous passive motion device, through time. In the opioid-sparing group, a lower VAS score with movement at postoperative 24 and 72 h was observed compared with the opioid-based group, but the difference did not reach the minimal clinically importance difference. A reduced cumulative morphine dose was noted in the opioid-sparing group at postoperative 24, 48 and 72 h. In conclusion, the opioid-sparing protocol may be used as an alternative modality for pain management following SBTKA. Similar pain relief effects may be achieved utilizing a reduced cumulative opioid dose, with few opioid related adverse events.

Sign in / Sign up

Export Citation Format

Share Document