scholarly journals Influence of inpatient opioid consumption on persistent use following total knee arthroplasty

2020 ◽  
pp. rapm-2020-101582
Author(s):  
Meredith Pace ◽  
Kerri Gannon ◽  
Matthew Friedland ◽  
Gervase Spurlin ◽  
Lori Lyn Price
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Optimal Recovery ◽  
Early Postoperative Period ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Increased Risk ◽  
Prescription Refill ◽  
Total Knee

BackgroundTotal knee arthroplasty (TKA) is associated with a high incidence of continued opioid use beyond the expected period of recovery. The aim of this study was to determine the influence of inpatient opioid consumption on the development of persistent use.MethodsOpioid-naïve patients undergoing primary, uncomplicated TKA were included in a prospective, observational study at a single institution. Postoperatively, opioids were prescribed by orthopedic advanced practitioners or resident physicians and administered by registered nurses. Individual inpatient prescriptions were adjusted, as needed, to facilitate optimal recovery conditions. Average hourly inpatient opioid consumption was calculated from total usage between midnight on the day of surgery until the time of hospital discharge. Persistent opioid use was defined as a prescription refill written by the orthopedic surgeon at the 6-week surgical follow-up visit. A multivariable regression model was used to identify independent risk factors associated with persistent use.ResultsA total of 351 patients were included in the analysis. Persistent opioid use was identified in 17.4% (61) of patients overall. A history of alcohol abuse (OR 7.80; 95% CI 2.13 to 28.55, p=0.002) was identified as an independent risk factor. Inpatient opioid consumption in the top quartile (equivalent to more than 10 mg of oxycodone every 4 hours) was not found to be associated with persistent use.ConclusionLarger amounts of opioid consumed in the hospital following uncomplicated, primary TKA may not be associated with an increased risk of persistent use at 6 weeks among opioid-naïve patients. Patients may have unique risk factors for prolonged opioid use that may not necessarily be apparent in the early postoperative period.

scholarly journals Modifiable, Postoperative Risk Factors for Delayed Discharge Following Total Knee Arthroplasty: The Influence of Hypotension and Opioid Use

2020 ◽  
Vol 35 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Albert T. Anastasio ◽  
Kevin X. Farley ◽  
Scott D. Boden ◽  
Thomas L. Bradbury ◽  
Ajay Premkumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Opioid Use ◽  
Delayed Discharge ◽  
Postoperative Risk ◽  
Total Knee

Risk factors for manipulation under anaesthesia after total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 66-72
Author(s):  
Paul Knapp ◽  
Luke Weishuhn ◽  
Natalie Pizzimenti ◽  
David C. Markel
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Fixation Method ◽  
Design Constraint ◽  
Discharge Disposition ◽  
Component Design ◽  
Increased Risk ◽  
Manipulation Under Anaesthesia ◽  
Total Knee

Aims Postoperative range of movement (ROM) is an important measure of successful and satisfying total knee arthroplasty (TKA). Reduced postoperative ROM may be evident in up to 20% of all TKAs and negatively affects satisfaction. To improve ROM, manipulation under anaesthesia (MUA) may be performed. Historically, a limited ROM preoperatively was used as the key harbinger of the postoperative ROM. However, comorbidities may also be useful in predicting postoperative stiffness. The goal was to assess preoperative comorbidities in patients undergoing TKA relative to incidence of postoperative MUA. The hope is to forecast those who may be at increased risk and determine if MUA is an effective form of treatment. Methods Prospectively collected data of TKAs performed at our institution’s two hospitals from August 2014 to August 2018 were evaluated for incidence of MUA. Comorbid conditions, risk factors, implant component design and fixation method (cemented vs cementless), and discharge disposition were analyzed. Overall, 3,556 TKAs met the inclusion criteria. Of those, 164 underwent MUA. Results Patients with increased age and body mass index (BMI) had decreased likelihood of MUA. For every one-year increase in age, the likelihood of MUA decreased by 4%. Similarly, for every one-unit increase in BMI the likelihood of MUA decreased by 6%. There were no differences in incidence of MUA between component type/design or fixation method. Current or former smokers were more likely to have no MUA. Surprisingly, patients discharged to home health service or skilled nursing facility were approximately 40% and 70% less likely than those discharged home with outpatient therapy to be in the MUA group. MUA was effective, with a mean increased ROM of 32.81° (SD 19.85°; -15° to 90°). Conclusion Younger, thinner patients had highest incidence of MUA. Effect of discharge disposition on rate of MUA was an important finding and may influence surgeons’ decisions. Interestingly, use of cement and component design (constraint) did not impact incidence of MUA. Level of Evidence II: Prospective cohort study. Cite this article: Bone Joint J 2020;102-B(6 Supple A):66–72.

Venous Thromboembolic Events after Total Knee Arthroplasty: Which Patients Are at a High Risk?

2019 ◽  
Vol 33 (10) ◽  
pp. 947-957 ◽  
Author(s):  
Wen-Li Dai ◽  
Ze-Ming Lin ◽  
Zhan-Jun Shi ◽  
Jian Wang
Keyword(s):  
United States ◽  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
The United States ◽  
Inhospital Mortality ◽  
Increased Risk ◽  
Venous Thromboembolic Events ◽  
Total Knee

AbstractVenous thromboembolism (VTE; deep venous thrombosis and pulmonary embolism) is a known complication following primary total knee arthroplasty (TKA). The aim of this study was to investigate the trends of the incidence of VTE after primary TKA and identify associated risk factors for the occurrence of VTEs in a large cohort of TKA patients. We performed a retrospective study in which the Nationwide Inpatient Sample (NIS) database was used to identify all patients who underwent primary TKA over a period of 13 consecutive years (between 2002 and 2014) in the United States. The occurrence of a symptomatic VTE was identified with the use of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes. A total of 1,460,901 primary TKA procedures were identified in the NIS from 2002 to 2014, and 12,944 of these patients were recorded as having 13,855 VTEs, consisting of 7,609 deep venous thromboses (0.52%) and 6,246 pulmonary emboli (0.43%). The overall VTE incidence in patients undergoing TKA in the United States from 2002 to 2014 was 0.89%. Patient-related risk factors for VTEs include an older age (odds ratio [OR]: 1.44; 95% confidence interval [CI]: 1.31–1.59), black race (OR: 1.34; 95% CI: 1.25–1.44), and Medicare insurance (OR: 1.18; 95% CI: 1.13–1.22). Most of the comorbidities were associated with an increased risk of VTE following TKA. Particularly, cardiac arrhythmias, coagulopathy, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss increased the risk of VTE by more than twofold. After adjusting for confounders, VTE was associated with a longer hospital stay (2.81 ± 0.02 day), increased costs (US$14,212.16 ± US$255.64), and higher mortality rate (OR: 13.04; 95% CI: 11.08–15.35). This nationally representative study of inpatients in the United States identified several independent risk factors for VTE perioperatively in TKA patients and provided evidence that VTE patients after TKA are likely to have worse results than non-VTE patients with regard to the length of hospital stay, hospital costs, and inhospital mortality. This is a level III, prognostic study.

Opioid Use After Total Knee Arthroplasty: Trends and Risk Factors for Prolonged Use

2017 ◽  
Vol 32 (8) ◽  
pp. 2390-2394 ◽  
Author(s):  
Nicholas A. Bedard ◽  
Andrew J. Pugely ◽  
Robert W. Westermann ◽  
Kyle R. Duchman ◽  
Natalie A. Glass ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Opioid Use ◽  
Total Knee

scholarly journals Risk factors for periprosthetic joint infection after total knee arthroplasty in Spanish population

2019 ◽  
Author(s):  
Francisco Melchor ◽  
David Pescador ◽  
Jose Mendoza ◽  
Agustin Diaz ◽  
Agustin Soler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
University Hospital ◽  
Spanish Population ◽  
Number Of Patients ◽  
Increased Risk ◽  
Total Knee

Abstract Background: Periprosthetic joint infection (PJI) is the most serious and feared complication in total knee arthroplasty (TKA) and can have catastrophic consequences. The number of total knee arthroplasties has increased and will continue to increase so that the number of infections will also be greater in the future. The aim of this study is to identify the most relevant risk factors associated with infection after a total knee prosthesis in a Spanish population. Methods: This is a case-control study of patients who underwent total knee arthroplasty at the University Hospital of Salamanca during the period January 1 2010 until January 1, 2015. TKA PJI was detected in 66 patients. As controls, a similar number of patients from the same period who did not develop a periprosthetic infection were included. Demographic and clinical variables were collected. A descriptive and inferential analysis was performed. Results: Diabetes, ASA grade, obesity and the use or not of antibiotic loaded cement were statistically significant related to the appearance of the infection. For the variables of surgical time and ischemia time, this relationship disappeared when the logistic regression was made. Conclusions: Our study provides evidence that diabetes, cement type, ASA and BMI were independently associated with increased risk of PJI for TKA patients in a Spanish population. We think that modifiable risk factors were specifically relevant and for that reason we can reduce the infection rate.

scholarly journals The Incidence and Risk Factors of Acute Kidney Disease after Total Knee Arthroplasty with Early Postoperative Volume Supplement

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Kuan-Ting Wu ◽  
Chung-Yang Chen ◽  
Bradley Chen ◽  
Jun-Wen Wang ◽  
Po-Chun Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Kidney Disease ◽  
Knee Arthroplasty ◽  
Significant Risk ◽  
Multivariate Logistic Regression Model ◽  
Increased Risk ◽  
Acute Kidney Disease ◽  
Total Knee ◽  
Artery Disease

Background. Etiology of acute kidney disease (AKD) after total knee arthroplasty (TKA) was considered as multifactorial. However, the role of early postoperative volume supplement in AKD rate has not been investigated. The purpose of this study was to evaluate the incidence and risk factors of AKD in patients with early volume supplement following TKA. Methods. This was a retrospective study with 458 patients who underwent unilateral TKA. All the patients received 6% tetrastarch, 7.5ml/kg, early in the postoperative period. Postoperative AKD was defined as the postoperative creatinine level ≥ 1.5 times compared with preoperative data. Potential variables associated with AKD were analyzed by multivariate logistic regression model to identify the AKD risk factors in TKA patients after early postoperative volume supplement. Results. The AKD rate was 3.3% (15 patients) in all patients. Age (OR = 1.09; P = .031) and coronary artery disease (CAD) (OR = 3.63; P = .034) were associated with increased risk of development of postoperative AKD. Other comorbidities as hypertension, diabetes, and CKD were not statistically significant risk factors. Conclusion. Our study demonstrated that age and CAD were independent risk factors of AKD in TKA patients. However, the common risk factors as hypertension, diabetes, and CKD were not significantly associated with AKD after TKA if early postoperative supplement of tetrastarch is administered.

Obesity and hypoalbuminaemia are independent risk factors for readmission and reoperation following primary total knee arthroplasty

2020 ◽  
Vol 102-B (6_Supple_A) ◽  
pp. 31-35 ◽  
Author(s):  
Matthew Sloan ◽  
Neil P. Sheth ◽  
Charles L. Nelson
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Improvement Program ◽  
Obesity Class ◽  
Increased Risk ◽  
Total Knee ◽  
Preoperative Albumin ◽  
Primary Total Knee

Aims Rates of readmission and reoperation following primary total knee arthroplasty (TKA) are under scrutiny due to new payment models, which penalize these negative outcomes. Some risk factors are more modifiable than others, and some conditions considered modifiable such as obesity may not be as modifiable in the setting of advanced arthritis as many propose. We sought to determine whether controlling for hypoalbuminaemia would mitigate the effect that prior authors had identified in patients with obesity. Methods We reviewed the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for the period of January 2008 to December 2016 to evaluate the rates of reoperation and readmission within 30 days following primary TKA. Multivariate logistic regression modelling controlled for preoperative albumin, age, sex, and comorbidity status. Results Readmission rates only differed significantly between patients with Normal Weight and Obesity Class II, with a decreased rate of readmission in this group (odds ratio (OR) 0.82; 95% confidence interval (CI) 0.71 to 0.96; p = 0.010). The only group demonstrating association with increased risk of reoperation within 30 days was the Obesity Class III group (OR 1.38; 95% CI 1.05 to 1.82; p = 0.022). Hypoalbuminaemia (preoperative albumin < 35 g/L) was significantly associated with readmission (OR 1.62; 95% CI 1.41 to 1.86; p < 0.001) and reoperation (OR 1.52; 95% CI 1.18 to 1.96; p = 0.001) within 30 days. Conclusion In this study, hypoalbuminaemia appears to be a more significant risk factor for readmission and reoperation than even the highest obesity categories. Future studies may assess whether preoperative albumin restoration or weight loss may improve outcomes for patients with hypoalbuminaemia. The implications of this study may allow surgeons to discuss risk of surgery with obese patients planning to undergo primary TKA procedures if other comorbidities are adequately controlled. Cite this article: Bone Joint J 2020;102-B(6 Supple A):31–35.

scholarly journals Safety and Efficacy of Perioperative Intravenous Meloxicam for Moderate-to-Severe Pain Management in Total Knee Arthroplasty: A Randomized Clinical Trial

Pain Medicine ◽  
2021 ◽  
Author(s):  
Richard D Berkowitz ◽  
Richard Steinfeld ◽  
Alexander P Sah ◽  
Randall J Mack ◽  
Stewart W McCallum ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Pain Management ◽  
Knee Arthroplasty ◽  
Controlled Trial ◽  
Primary Total Knee Arthroplasty ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Analgesic Regimen ◽  
Management Protocol ◽  
Total Knee

Abstract Objective To evaluate the effect of perioperative meloxicam IV 30 mg on opioid consumption in primary total knee arthroplasty (TKA). Design Multicenter, randomized, double-blind, placebo-controlled trial. Subjects 181 adults undergoing elective primary TKA. Methods Subjects received meloxicam 30 mg or placebo via an IV bolus every 24 hours, the first dose administered prior to surgery as part of a multimodal pain management protocol. The primary efficacy parameter was total opioid use from end of surgery through 24 hours. Results Meloxicam IV was associated with less opioid use versus placebo during the 24 hours after surgery (18.9 ± 1.32 vs 27.7 ± 1.37 mg IV morphine equivalent dose; P &lt; 0.001) and was superior to placebo on secondary endpoints, including summed pain intensity (first dose to 24 hrs postdosing, first dose to first assisted ambulation, and first dose to discharge) and opioid use (48–72 hrs., 0–48 hrs., 0–72 hrs., hour 0 to end of treatment, and the first 24 hours after discharge). Adverse events (AEs) were reported for 69.9% and 92.0% of the meloxicam IV and placebo groups, respectively; the most common AEs were nausea (40% vs. 59%), vomiting (16% vs. 22%), hypotension (14% vs. 15%), pruritus (15% vs. 11%), and constipation (11% vs. 13%). Conclusions Perioperative meloxicam IV 30 mg as part of a multimodal analgesic regimen for elective primary TKA reduced opioid consumption in the 24-hour period after surgery versus placebo and was associated with a lower incidence of AEs typically associated with opioid use.

scholarly journals Risk Factors of Opioid use Associated with an Enhanced-Recovery Programme after Total Knee Arthroplasty

2021 ◽  
Author(s):  
Guorui Cao ◽  
Fuxing Pei
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Protective Factor ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Opioid Use ◽  
Enhanced Recovery Programme ◽  
Total Knee

Abstract Background: The relationship between total knee arthroplasty (TKA) and postoperative opioid use is poorly studied. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA.Methods: We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Multivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were recorded and compared.Results: The prevalence of opioid use after primary TKA was 23.0%. Significant risk factor were more operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and protective factor was tranexamic acid use (OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05).Conclusion: Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use. Reducing operative time and application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

scholarly journals Risk factors of opioid use associated with an enhanced-recovery programme after total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Guorui Cao ◽  
Shiqi Xiang ◽  
Minglu Yang ◽  
Songtao Quan ◽  
Junna Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Protective Factor ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Opioid Use ◽  
Enhanced Recovery Programme ◽  
Total Knee

Abstract Background Characterizing the impacts of postoperative opioid use on total knee arthroplasty (TKA) patients may help optimize the pain management after TKA. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA. Methods We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Themultivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were also recorded and compared. Results The prevalence of opioid use after primary TKA was 23.0%. The significant risk factor was the longer operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and the protective factor was the utilization of tranexamic acid(OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05). Conclusion Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use after TKA. Reducing operative time and the application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

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