scholarly journals Preoperative Cognitive Impairment as a Perioperative Risk Factor in Patients Undergoing Total Knee Arthroplasty

2021 ◽  
Vol 12 ◽  
pp. 215145932110045
Author(s):  
Sindhu Krishnan ◽  
Ethan Y. Brovman ◽  
Richard D. Urman
Keyword(s):  
Total Knee Arthroplasty ◽  
Cognitive Impairment ◽  
Length Of Stay ◽  
Functional Status ◽  
Knee Arthroplasty ◽  
Pilot Project ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
Total Knee

Background: The study assessed whether pre-existing cognitive impairment (CI) prior to elective total knee arthroplasty (TKA) is associated with worse postoperative outcomes such as delirium, in-hospital medical complications, 30-day mortality, hospital length of stay and non-home discharge. Methods: A retrospective database analysis from the NSQIP Geriatric Surgery Pilot Project was used. There was an initial cohort of 6350 patients undergoing elective TKA, 104 patients with CI were propensity score matched to 104 patients without CI. Results: Analysis demonstrated a significantly increased incidence of post-operative delirium (POD) in the cohort with pre-op CI (p = < .001), a worsened functional status (p = < .001) and increased nonhome discharge postoperatively compared to the group without CI (p = 0.029). Other post-operative outcomes included 30-day mortality of 0% in both groups, and low rate of complications such as infection (2.88% vs 0.96%), pneumonia (1.92% vs 0%), failure to wean (0.96% vs 0%), and reintubation (0.96% vs 0%). Some other differences between the CI group and non-CI group, although not statistically significant, included increased rate of transfusion (10.58% vs 6.73%), and sepsis (1.92% vs 0%). The length of stay was increased in the non-CI group (4.28% vs 2.32%, p = 0.122). Conclusion: CI in patients undergoing TKA is associated with an increased risk of POD, worsened postoperative functional status, and discharge to non-home facility.

scholarly journals Preoperative Predictors of Extended Hospital Length of Stay Following Total Knee Arthroplasty

2015 ◽  
Vol 30 (3) ◽  
pp. 361-364 ◽  
Author(s):  
Mohamad J. Halawi ◽  
Tyler J. Vovos ◽  
Cindy L. Green ◽  
Samuel S. Wellman ◽  
David E. Attarian ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Knee ◽  
Preoperative Predictors

scholarly journals The effect of operative time on in-hospital length of stay in revision total knee arthroplasty

2019 ◽  
Vol 7 (4) ◽  
pp. 66-66 ◽  
Author(s):  
Luke J. Garbarino ◽  
Peter A. Gold ◽  
Nipun Sodhi ◽  
Hiba K. Anis ◽  
Joseph O. Ehiorobo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Revision Total Knee Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Knee

Comparison of the Effects of Intravenous and Oral Tranexamic Acid on Perioperative Hemoglobin Levels During Total Knee Arthroplasty

2019 ◽  
Vol 54 (2) ◽  
pp. 138-143 ◽  
Author(s):  
Sophia Pathan ◽  
Joseph E. Cruz ◽  
Patrick Curtin
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Orthopedic Surgeons ◽  
Total Knee

Background: Tranexamic acid (TXA) is an antifibrinolytic agent shown to reduce perioperative blood loss in patients undergoing total knee arthroplasty (TKA), but there are limited data regarding the efficacy of intravenous (IV) in comparison to oral (PO) TXA. Objective: The purpose of this research was to compare the effects of IV and PO TXA on perioperative hemoglobin (Hgb) levels in patients who have undergone TKA. Methods: In this single-center, retrospective chart review, patients at least 18 years of age who received IV or PO TXA following medical center protocol from 1 of 3 orthopedic surgeons were included. The primary outcome was the change in Hgb within 24 hours following TKA. Secondary outcomes included comparisons of postsurgical complications and hospital length of stay. Results: The IV TXA group contained 62 participants, and the PO TXA group contained 61 participants. Patients receiving PO therapy had a larger decrease in Hgb compared with the IV TXA group (−2.382 vs −1.908, P = 0.02), but there were no statistically significant differences in mean length of stay (3.13 vs 2.95, P = 0.27), venous thromboembolism (VTE) occurrence (0 vs 0, P = 1), or requirement for transfusions (6 vs 5, P = 0.76). Conclusions and Relevance: IV and PO TXA may not be equivalent in outcomes for patients undergoing TKA. This study found a statistically significant decrease in the mean change of Hgb in patients receiving PO TXA compared with IV TXA. However, the rate of transfusions, mean length of stay, and rate of VTE were similar between groups.

scholarly journals Decreasing hospital length of stay and enhancing recovery in Total Knee Arthroplasty

2020 ◽  
Vol 11 (1) ◽  
pp. 122-128 ◽  
Author(s):  
Sanjay Agarwala ◽  
Manju Butani ◽  
Jacqueline D'Mello ◽  
Shalini Saksena ◽  
Aditya Menon
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Total Knee

Accelerated Discharge following Total Knee Arthroplasty May Be Safe in a Teaching Institution

2018 ◽  
Vol 33 (01) ◽  
pp. 008-011 ◽  
Author(s):  
Thomas A. Novack ◽  
Jennifer Kurowicki ◽  
Kimona Issa ◽  
Todd P. Pierce ◽  
Anthony Festa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Surgical Complication ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Complication Rates ◽  
Readmission Rates ◽  
Teaching Institution ◽  
Increased Risk ◽  
Total Knee

AbstractTotal knee arthroplasty (TKA) is one of the most commonly performed yet costly surgical procedures in orthopaedics. With national trends and reimbursements moving in favor of shorter hospital length-of-stay (LOS), it is important to understand the complications associated with discharging patients earlier. This is particularly more challenging in a teaching institution due to complexity and variety of layers of care. Therefore, the purpose of this study was to evaluate the 90-day postoperative outcomes among those who were discharged on postoperative day 2 (POD-2) and compare them to a cohort whom had a LOS ≥ 3 days. A retrospective review of all patients who underwent a primary TKA from at a single-teaching institution from 2015 to 2017 was performed. During this time, an accelerated discharge protocol was designed and implanted in our institution. We identified 485 patients who were then substratified into two groups: patients who were discharged on POD-2 (n = 91) with the accelerated protocol and those who were discharged ≥ 3 days (n = 394). Outcomes evaluated included (1) demographics, (2) readmission rates, (3) emergency room (ER) visits, and (4) complication rates within 90 days of TKA. The POD-2 cohort was significantly younger than patients with ≥ 3-day LOS (64 vs. 69 years; p = 0.0001). There were no differences in gender ratios between the 2-day and 3-day cohorts (women, 67 vs. 72%; p = 0.34). Readmission rates (2 vs. 5%; p = 0.31) and ER visits were similar between cohorts (9 vs. 6%; p = 0.4). Medical and surgical complication rates did not differ between the two cohorts, with an overall complication rate of 5.5% in POD-2 versus 5.6% in >3 days LOS (p = 0.97). Patients discharged on POD-2 from TKA did not demonstrate an increased risk of complications, ER visits, or readmissions within 90 days in a teaching institution. However, older patients tended to have a longer LOS.

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