The BTK Safety Score: A Novel Scoring System for Risk Stratifying Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty

2022 ◽  
Author(s):  
Kevin Y. Wang ◽  
Varun Puvanesarajah ◽  
Micheal Raad ◽  
Kawsu Barry ◽  
Umasuthan Srikumaran ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pulmonary Disease ◽  
Knee Arthroplasty ◽  
Scoring System ◽  
Area Under The Curve ◽  
Chronic Obstructive ◽  
Improvement Program ◽  
Bilateral Total Knee Arthroplasty ◽  
Obstructive Pulmonary Disease ◽  
Total Knee

AbstractSelection of appropriate candidates for simultaneous bilateral total knee arthroplasty (si-BTKA) is crucial for minimizing postoperative complications. The aim of this study was to develop a scoring system for identifying patients who may be appropriate for si-BTKA. Patients who underwent si-BTKA were identified in the National Surgical Quality Improvement Program database. Patients who experienced a major 30-day complication were identified as high-risk patients for si-BTKA who potentially would have benefitted from staged bilateral total knee arthroplasty. Major complications included deep wound infection, pneumonia, renal insufficiency or failure, cerebrovascular accident, cardiac arrest, myocardial infarction, pulmonary embolism, sepsis, or death. The predictive model was trained using randomly split 70% of the dataset and validated on the remaining 30%. The scoring system was compared against the American Society of Anesthesiologists (ASA) score, the Charlson Comorbidity Index (CCI), and legacy risk-stratification measures, using area under the curve (AUC) statistic. Total 4,630 patients undergoing si-BTKA were included in our cohort. In our model, patients are assigned points based on the following risk factors: +1 for age ≥ 75, +2 for age ≥ 82, +1 for body mass index (BMI) ≥ 34, +2 for BMI ≥ 42, +1 for hypertension requiring medication, +1 for pulmonary disease (chronic obstructive pulmonary disease or dyspnea), and +3 for end-stage renal disease. The scoring system exhibited an AUC of 0.816, which was significantly higher than the AUC of ASA (0.545; p < 0.001) and CCI (0.599; p < 0.001). The BTK Safety Score developed and validated in our study can be used by surgeons and perioperative teams to risk stratify patients undergoing si-BTKA. Future work is needed to assess this scoring system's ability to predict long-term functional outcomes.

Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty

2018 ◽  
Vol 33 (8) ◽  
pp. 2623-2626 ◽  
Author(s):  
George A. Yakubek ◽  
Gannon L. Curtis ◽  
Anton Khlopas ◽  
Mhamad Faour ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Total Knee Arthroplasty ◽  
Pulmonary Disease ◽  
Knee Arthroplasty ◽  
Chronic Obstructive ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Total Knee

Chronic Obstructive Pulmonary Disease Associated with Prolonged Opiate Use, Increased Short-Term Complications, and the Need for Revision Surgery following Total Knee Arthroplasty

2021 ◽  
Author(s):  
Nicholas J. Lemme ◽  
Jillian Lynn Glasser ◽  
Daniel S. Yang ◽  
Edward J. Testa ◽  
Alan H. Daniels ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Total Knee Arthroplasty ◽  
Pulmonary Disease ◽  
Knee Arthroplasty ◽  
Surgical Complications ◽  
Medical Complications ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Total Knee

AbstractChronic obstructive pulmonary disease (COPD) is a condition which causes a substantial burden to patients, physicians, and the health care system at large. Medical comorbidities are commonly associated with adverse health outcomes in the postoperative period. Here, we present a large database review of patients undergoing total knee arthroplasty (TKA) to determine the effect of COPD on patient outcomes. The PearlDiver database was queried for all patients who underwent TKA between 2007 and the first quarter of 2017. Medical complications, surgical complications, 30-day readmission rates, revision rates, and opioid utilization were assessed at various intervals following TKA among patients with and without COPD. Multivariable regression was used to calculate adjusted odds ratios controlling for age, sex, and medical comorbidities. A total of 46,769 TKA patients with COPD and 120,177 TKA patients without COPD were studied. TKA patients with COPD experienced increased risk of 30-day readmission (40.8% vs. 32.2%, p < 0.0001), 30-day total medical complications (10.2% vs. 7.0%, p < 0.0001), prosthesis explanation at 6 months (0.4% vs. 0.2, p = 0.0130), 1 year (0.6% vs. 0.3%, p = 0.0005), and 2 years (0.8% vs. 0.5%, p = 0.0003), as well as an increased rate of revision (p < 0.0046) compared to TKA patients without COPD. Opioid utilization of TKA patients with COPD was greater significantly than that of TKA patients without COPD at 3, 6, and 12 months. Patients with COPD have an increased risk for medical and surgical complications, readmission, and prolonged opioid use following TKA.

Social determinants of health in total knee arthroplasty

2021 ◽  
Vol 103-B (6 Supple A) ◽  
pp. 113-118 ◽  
Author(s):  
Ronald E. Delanois ◽  
John M. Tarazi ◽  
Wayne A. Wilkie ◽  
Ethan Remily ◽  
Hytham S. Salem ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Total Knee Arthroplasty ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Knee Arthroplasty ◽  
Food Deserts ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Total Knee

Aims Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure. Methods Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters. Results Divorced status was significantly associated with an increased LOS (p = 0.043). Comorbidities significantly associated with an increased LOS included chronic obstructive pulmonary disease/asthma and congestive heart failure (p = 0.043 and p = 0.001, respectively). Communities with a higher density of tobacco stores were significantly associated with an increased LOS (p = 0.017). Comorbidities significantly associated with an increased TCOC included chronic obstructive pulmonary disease (p = 0.004), dementia (p = 0.048), and heart failure (p = 0.007). Increased TCOCs were significantly associated with patients who lived in food deserts (p = 0.001) and in areas with an increased density of tobacco stores (p = 0.023). Conclusion Divorced marital status was significantly associated with an increased LOS following TKA. Living in food deserts and in communities with more tobacco stores were significant risk factors for increased LOS and TCOC. Food access and ease of acquiring tobacco may both prove to be prognostic of outcome after TKA and an opportunity for intervention. Cite this article: Bone Joint J 2021;103-B(6 Supple A):113–118.

scholarly journals Optimal Age Group Selection and Development of a Nomogram To Predict Complications in Patients Undergoing Simultaneous Bilateral Total Knee Arthroplasty

2021 ◽  
Author(s):  
Kui-shuai XU ◽  
Liang ZHANG ◽  
Zhongkai REN ◽  
Tianrui WANG ◽  
Xia ZHAO ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Calibration Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Operation Time ◽  
Age Group ◽  
Bilateral Total Knee Arthroplasty ◽  
Actual Observation ◽  
Total Knee

Abstract Purpose By comparing the occurrence of complications at 30 days after Simultaneous bilateral total knee arthroplasty (SBTKA) for each age group, the optimal age range of patients receiving SBTKA was determined.An individualized histogram model was established to predict complications within 30 days after SBTKA. Methods The general data of 861 patients who received SBTKA in our hospital on January 1, 2012 and March 31, 2017 were retrospectively analyzed. According to the age of the patients, they were divided into four ages: less than 60 years old, 60 to 64 years old, 65 to 69 years old and over 70 years old. The incidence of complications in different ages was studied.According to the occurrence of complications, 96 cases were included in the complication group and 765 cases in the non-complication group. Univariate and multivariate Logistic regression analysis was conducted to determine and screen out the independent risk factors for complications after SBTKA, and then R software was used to construct the prediction model of the nomogram.The area under the curve (AUC), calibration curve, and decision curve analysis (DCA) were selected to evaluate the nomogram. Results Patients aged 60 to 64 years had the lowest overall postoperative complication rate (7.17%).Five independent predictors were identified by multivariate analysis and were used to establish the nomogram.The AUC of the nomogram was 0.851(95%CI:0.819–0.883).The calibration curve showed that the prediction of nomogram was highly consistent with the actual observation, and DCA showed that nomogram had good clinical usefulness. Conclusion The optimal age group for SBTKA is between 60 and 64 years of age, where the incidence of complications is lowest.Older age, lower preoperative hemoglobin levels, higher preoperative blood urea nitrogen(BUN) levels, longer operation time, and ASA grade ≥ III were identified as independent predictors of complications within 30 days after SBTKA.A nomogram containing the above five predictors could accurately predict the risk of complications within 30 days after SBTKA.

Impact of Chronic Obstructive Pulmonary Disease on Postoperative Complications Following Simultaneous Bilateral Total Knee Arthroplasty

2019 ◽  
Author(s):  
Alex Gu ◽  
Shitong Wu ◽  
Fabio Mancino ◽  
Jiabin Liu ◽  
Michael P. Ast ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Total Knee Arthroplasty ◽  
Chronic Obstructive ◽  
Thromboembolic Complications ◽  
Bilateral Total Knee Arthroplasty ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
Total Knee ◽  
The Impact ◽  
Simultaneous Bilateral Tka

AbstractFor patients who qualify, simultaneous bilateral total knee arthroplasty (TKA) is a viable option for the treatment of bilateral symptoms. However, the incidence of chronic obstructive pulmonary disease (COPD) has been steadily rising over the past few decades and may impact those who qualify as candidates for bilateral TKA. As such, the aim of this study was to determine the impact of COPD on postoperative outcomes in patients who receive simultaneous bilateral TKA. A retrospective cohort study was conducted utilizing data provided through the American College of Surgeons National Surgical Quality Improvement Program. All patients who had undergone simultaneous bilateral TKA between 2007 and 2016 were identified and further stratified into groups based upon the COPD status. Incidence of adverse events after TKA in the acute postoperative period was evaluated with univariate and multivariate analyses. COPD was found to be an independent risk factor for the development of major (odds ratio [OR]: 2.5; p = 0.015), renal (OR: 5.1; p = 0.02), and thromboembolic complications (OR: 2.5; p = 0.027). In addition, patients with COPD were at increased risk for having an extended hospital length of stay (LOS; p < 0.001) and development of urinary tract infections (p < 0.001). Patients with COPD are at higher risk for development of overall major complications, as well as renal and thromboembolic complications after simultaneous bilateral TKA. Interestingly, patients were not at increased risk for the development of pulmonary or wound complications. When considering a staged versus simultaneous bilateral TKA, surgeons should be aware of the impact COPD status has on the postoperative complication rate.

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

Blood Management in Total Knee Arthroplasty: A Nationwide Analysis from 2011 to 2018

2020 ◽  
Author(s):  
Jared A. Warren ◽  
John P. McLaughlin ◽  
Robert M. Molloy ◽  
Carlos A. Higuera ◽  
Jonathan L. Schaffer ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Platelet Count ◽  
Knee Arthroplasty ◽  
Categorical Variables ◽  
Bleeding Disorders ◽  
Blood Management ◽  
Improvement Program ◽  
Preoperative Anemia ◽  
High Incidence ◽  
Total Knee

AbstractBoth advances in perioperative blood management, anesthesia, and surgical technique have improved transfusion rates following primary total knee arthroplasty (TKA), and have driven substantial change in preoperative blood ordering protocols. Therefore, blood management in TKA has seen substantial changes with the implementation of preoperative screening, patient optimization, and intra- and postoperative advances. Thus, the purpose of this study was to examine changes in blood management in primary TKA, a nationwide sample, to assess gaps and opportunities. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify TKA (n = 337,160) cases from 2011 to 2018. The following variables examined, such as preoperative hematocrit (HCT), anemia (HCT <35.5% for females and <38.5% for males), platelet count, thrombocytopenia (platelet count < 150,000/µL), international normalized ration (INR), INR > 2.0, bleeding disorders, preoperative, and postoperative transfusions. Analysis of variances were used to examine changes in continuous variables, and Chi-squared tests were used for categorical variables. There was a substantial decrease in postoperative transfusions from high of 18.3% in 2011 to a low of 1.0% in 2018, (p < 0.001), as well as in preoperative anemia from a high of 13.3% in 2011 to a low of 9.5% in 2016 to 2017 (p < 0.001). There were statistically significant, but clinically irrelevant changes in the other variables examined. There was a HCT high of 41.2 in 2016 and a low of 40.4 in 2011 to 2012 (p < 0.001). There was platelet count high of 247,400 in 2018 and a low of 242,700 in 201 (p < 0.001). There was a high incidence of thrombocytopenia of 5.2% in 2017 and a low of low of 4.4% in 2018 (p < 0.001). There was a high INR of 1.037 in 2011 and a low of 1.021 in 2013 (p < 0.001). There was a high incidence of INR >2.0 of 1.0% in 2012 to 2015 and a low of 0.8% in 2016 to 2018 (p = 0.027). There was a high incidence of bleeding disorders of 2.9% in 2013 and a low of 1.8% in 2017 to 2018 (p < 0.001). There was a high incidence of preoperative transfusions of 0.1% in 2011 to 2014 and a low of <0.1% in 2015 to 2018 (p = 0.021). From 2011 to 2018, there has been substantial decreases in patients receiving postoperative transfusions after primary TKA. Similarly, although a decrease in patients with anemia was seen, there remains 1 out 10 patients with preoperative anemia, highlighting the opportunity to further improve and address this potentially modifiable risk factor before surgery. These findings may reflect changes during TKA patient selection, optimization, or management, and emphasizes the need to further advance multimodal approaches for perioperative blood management of TKA patients. This is a Level III study.

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