scholarly journals Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
David M. Dalton ◽  
Enda G. Kelly ◽  
Terence P. Murphy ◽  
Gerry F. McCoy ◽  
Aaron A. Glynn
Keyword(s):  
Retrospective Study ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Cardiac Disease ◽  
Preoperative Assessment ◽  
Joint Arthroplasty ◽  
Assessment Clinic ◽  
Specialty Hospital ◽  
Day Of Surgery Admission ◽  
Low Rate

Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty.Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation.Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC).Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n=27), followed by pulmonary disease (n=22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date.Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation.

Impact of Weight-Band Dosing of Tinzaparin for Venous Thromboembolism Prophylaxis on Persistent Wound Drainage in Adult Patients Undergoing Hip and Knee Arthroplasty

2021 ◽  
pp. 106002802110242
Author(s):  
Cassandra Cooper ◽  
Ouida Antle ◽  
Jennifer Lowerison ◽  
Deonne Dersch-Mills ◽  
Ashley Kenny
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Thromboembolism Prophylaxis ◽  
Wound Drainage ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact

Background: Persistent wound drainage and venous thromboembolism (VTE) are potential complications of total joint arthroplasty, and these risks can be challenging to balance in clinical practice. Anecdotal observation has suggested that following joint arthroplasty, persistent wound drainage occurs more frequently with higher body weight and higher doses of tinzaparin when compared with lower body weight and lower doses of tinzaparin. Objective: The overall purpose of this study was to describe the impact of a tinzaparin weight-band dosing table for VTE prophylaxis on wound healing, thrombosis, and bleeding outcomes in patients undergoing total joint arthroplasty. Methods: This retrospective chart review included patients who underwent total hip or knee arthroplasty and received tinzaparin for thromboprophylaxis per their weight-banding category. The primary outcome was the incidence of persistent wound drainage. Secondary outcomes include the occurrence of VTE and clinically important bleeding during hospital admission. Results: A total of 231 patients were included in the analysis. There was no significant difference in persistent wound drainage between the 3 weight categories, and there were no differences in rates of VTE or clinically important bleeding. Concurrent use of low-dose acetylsalicylic acid was associated with a 3-fold increased risk of persistent wound drainage (risk ratio = 3.35; 95% CI = 2.14-5.24; P = 0.00003). Conclusion and Relevance: In joint arthroplasty patients, we observed no significant difference in rates of persistent wound drainage between various weight categories receiving different weight-banded doses of tinzaparin. Our results do not suggest that the current weight-band dosing table for tinzaparin needs to be adjusted to optimize patient outcomes.

Dexamethasone and perioperative blood glucose in patients undergoing total joint arthroplasty: A retrospective study

2017 ◽  
Vol 37 ◽  
pp. 116-122 ◽  
Author(s):  
Michael Nurok ◽  
Jennifer Cheng ◽  
Giulio R. Romeo ◽  
Stephanie M. Vecino ◽  
Kara G. Fields ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Blood Glucose ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty

Ceforanide vs. Cephalothin Concentrations in Total Joint Arthroplasty

1983 ◽  
Vol 17 (9) ◽  
pp. 645-648 ◽  
Author(s):  
William J. Cady ◽  
Bradley G. Wulf ◽  
Michael T. O'Neil ◽  
Dwight W. Burney ◽  
William R. Hamsa
Keyword(s):  
Total Knee Arthroplasty ◽  
Synovial Fluid ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Plasma Concentrations ◽  
Prophylactic Antibiotic ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
Orthopedic Procedure ◽  
Total Knee

Total joint arthroplasty is a common orthopedic procedure and requires prophylactic antibiotic coverage to prevent infections in the operated joint. The antibiotics routinely used for prophylaxis are the cephalosporins. This study compared bone, synovial fluid, and plasma concentrations of ceforanide with cephalothin concentrations in 30 patients undergoing elective total hip or total knee arthroplasty. Ceforanide provided significantly higher plasma concentrations for 61–110 minutes postdose than did cephalothin (p < 0.025 and p < 0.005). No difference was noted between the two antibiotics for the bone concentrations in the total hip arthroplasty group; however, cephalothin concentrated to a greater degree in the bone of patients undergoing total knee arthroplasty (p < 0.05). Cephalothin achieved higher concentrations in the synovial fluid than did ceforanide (p < 0.05). Both antibiotics were well tolerated and no postoperative infections were noted in either group.

scholarly journals Neuraxial and general anesthesia for outpatient total joint arthroplasty result in similarly low rates of major perioperative complications: a multicentered cohort study

2022 ◽  
pp. rapm-2021-103189
Author(s):  
Edward Yap ◽  
Julia Wei ◽  
Christopher Webb ◽  
Kevin Ng ◽  
Matthias Behrends
Keyword(s):  
Cohort Study ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Outpatient Surgery ◽  
Joint Arthroplasty ◽  
Neuraxial Anesthesia ◽  
General Anesthesia Group ◽  
Increased Risk ◽  
Same Day Discharge

BackgroundNeuraxial anesthesia when compared with general anesthesia has shown to improve outcomes following lower extremity total joint arthroplasty. It is unclear whether these benefits are present in outpatient surgery given the selection of healthier patients.ObjectiveTo compare the effects of neuraxial versus general anesthesia on outcomes following ambulatory hip and knee arthroplasty.MethodsMulticentered retrospective cohort study in ambulatory hip or knee arthroplasty patients between January 2017 and December 2019. Primary endpoint examined 30-day major postoperative complications (mortality, myocardial infarction, deep venous thromboembolism, pulmonary embolism, stroke, and acute renal failure).ResultsOf 11 523 eligible patients identified, 10 003 received neuraxial anesthesia, while 1520 received general anesthesia. 30-day major complications did not differ between neuraxial anesthesia and general anesthesia groups (1.8% vs 2.3%; aOR=0.85, CI: 0.56 to 1.27, p=0.39). There was no difference in 30-day minor complications (surgical site infection, pneumonia, urinary tract infection; 3.3% vs 4.1%; aOR=0.83, CI: 0.62 to 1.14, p=0.23). The neuraxial group demonstrated reduced pain and analgesia requirements and had less postoperative nausea and vomiting (PONV). Median recovery room length of stay was shorter by 52 min in the general anesthesia group, but these patients were more likely to fail same day discharge (33% vs 23.4%; p<0.01).ConclusionAnesthesia type was not associated with an increased risk for complications. However, neuraxial anesthesia improved outcomes that predict readiness for discharge: patients had less pain, required less opioids, and had a lower incidence of PONV, thus improving the rate of same day discharge.Trial registration numberNCT04203732.

scholarly journals Predictors for readmission following primary total hip and total knee arthroplasty

2020 ◽  
Vol 28 (3) ◽  
pp. 230949902095916
Author(s):  
Ong-art Phruetthiphat ◽  
Jesse E Otero ◽  
Biagio Zampogna ◽  
Sebastiano Vasta ◽  
Yubo Gao ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Multivariate Regression ◽  
The United States ◽  
Joint Arthroplasty ◽  
Hospital Length Of Stay ◽  
Common Cause ◽  
Total Hip ◽  
Total Knee

Background: Readmission following total joint arthroplasty has become a closely watched metric for many hospitals in the United States due to financial penalties imposed by Centers for Medicare and Medicaid Services. The purpose of this study was to identify both preoperative and postoperative reasons for readmission within 30 days following primary total hip and total knee arthroplasty (TKA). Methods: Retrospective data were collected for patients who underwent elective primary total hip arthroplasty (THA; CPT code 27130) and TKA (27447) from 2008 to 2013 at our institution. The sample was separated into readmitted and nonreadmitted cohorts. Demography, comorbidities, Charlson comorbidity index (CCI), operative parameters, readmission rates, and causes of readmission were compared between the groups using univariate and multivariate regression analysis. Results: There were 42 (3.4%) and 28 (2.2%) readmissions within 30 days for THA and TKA, respectively. The most common cause of readmission within 30 days following total joint arthroplasty was infection. Trauma was the second most common reason for readmission of a THA while wound dehiscence was the second most common cause for readmission following TKA. With univariate regression, there were multiple associated factors for readmission among THA and TKA patients, including body mass index, metabolic equivalent (MET), and CCI. Multivariate regression revealed that hospital length of stay was significantly associated with 30-day readmission after THA and TKA. Conclusion: Patient comorbidities and preoperative functional capacity significantly affect 30-day readmission rate following total joint arthroplasty. Adjustments for these parameters should be considered and we recommend the use of CCI and METs in risk adjustment models that use 30-day readmission as a marker for quality of patient care. Level of Evidence: Level III/Retrospective cohort study

scholarly journals Letter to the Editor: How Accurate Are the Surgical Risk Preoperative Assessment System (SURPAS) Universal Calculators in Total Joint Arthroplasty?

2020 ◽  
Vol 478 (8) ◽  
pp. 1946-1947 ◽  
Author(s):  
William G. Henderson ◽  
Robert A. Meguid ◽  
Karl E. Hammermeister ◽  
Kathryn L. Colborn ◽  
Paul D. Rozeboom ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Preoperative Assessment ◽  
Joint Arthroplasty ◽  
Assessment System ◽  
Surgical Risk ◽  
Letter To The Editor

scholarly journals Functional outcomes after total joint arthroplasty are related to the severity of Parkinson’s disease: a mid-term follow-up

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Xiao Rong ◽  
Suraj Dahal ◽  
Ze-yu Luo ◽  
Kai Zhou ◽  
Shun-Yu Yao ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Joint Arthroplasty ◽  
Functional Outcomes ◽  
Joint Arthroplasty ◽  
Total Hip ◽  
Total Knee

Abstract Background Performing total joint arthroplasty (TJA) in Parkinson’s disease (PD) patients may encounter a higher complication rate or worse functional outcomes compared with common patients. The relationship between PD and clinical outcomes after TJA is not fully understood. Methods Retrospectively, we used manual charts to investigate the clinical outcomes in 41 patients including 24 total hip arthroplasty (THA) patients (28 hips) and 18 total knee arthroplasty (TKA) patients (22 knees) with a diagnosis of PD from 2009 to 2016. The stage of PD was confirmed by Hoehn and Yahr scale. Prosthesis survivorship was estimated with revision for any reason as the endpoint. Result All the clinical outcomes improved significantly (p < 0.05). Subgroup analysis revealed worse functional outcomes in mid- or end-stage PD patients. Sixteen short-term mild to moderate complications were noted. Two revisions were conducted for hip periprosthetic osteolysis and postoperative knee pain. The prosthesis survivorship at 60 months for TJA, total hip arthroplasty (THA), or total knee arthroplasty (TKA) was 91.6%, 94.1%, and 87.5%, respectively. Conclusion Patients with PD who underwent TJA would result in excellent pain relief and gain of function. However, patients at late-stage PD may suffer from functional loss. The effectiveness of TJA in patients with severe PD remains a concern. Physician should help delay the progression of PD which may optimize and stabilize the functional outcomes of TJA.

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