scholarly journals Does dehydration prior to primary total joint arthroplasty increase risk of perioperative complications?

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Harold G. Moore ◽  
Marissa A. Justen ◽  
David S. Kirwin ◽  
Patrick J. Burroughs ◽  
Lee E. Rubin ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Perioperative Complications ◽  
Joint Arthroplasty ◽  
Perioperative Outcomes ◽  
Hydration Status ◽  
Improvement Program ◽  
Increased Risk ◽  
Increase Risk ◽  
Total Knee

Abstract Background Prior studies have suggested that preoperative dehydration increases odds of perioperative complications in several areas of orthopedic surgery. This study aimed to evaluate whether preoperative hydration status is associated with the incidence of short-term complications after primary total joint arthroplasty. Methods The 2012–2019 National Surgical Quality Improvement Program (NSQIP) database was used to explore the relationship between preoperative dehydration (ratio of preoperative BUN divided by preoperative Creatinine (BUN/Creatinine) > 20) and perioperative outcomes of total hip (THA) and total knee arthroplasty (TKA) patients. Univariate comparisons and multivariate regression analyses were conducted to identify specific complications that occurred more often in patients with preoperative dehydration. Results Of 188,629 THA and 332,485 TKA patients, 46.3 and 47.0% had preoperative dehydration, respectively. After controlling for demographics and comorbidities, dehydrated THA patients were no more likely to experience a complication compared to their non-dehydrated counterparts (relative risk [RR] = 0.97, 99.7% Confidence Interval [CI]: 0.92–1.03, P = 0.138) nor increased risk of blood transfusion (RR = 1.02, CI = 0.96–1.08, P = 0.408). Similar to THA patients, dehydrated TKA patients were not more likely to have a complication after surgery (RR = 0.97, CI = 0.92–1.03, P = 0.138) and were at no greater risk of transfusion (RR = 1.02, CI = 0.96–1.07, P = 0.408). A sub-analysis covering only patients with BUN and Cr values determined within 24 h after surgery was performed and similarly found no significant increase in perioperative complications or transfusion. Conclusion Overall, preoperative dehydration in patients undergoing THA/TKA did not appear to increase risk of transfusion or other perioperative complications. Further research is needed to characterize the role of hydration prior to elective total joint arthroplasty.

Dialysis Is Not Associated with Increased Risk of Perioperative Complications in TKA Patients after Adjusting for Pertinent Confounders

2019 ◽  
Vol 33 (08) ◽  
pp. 745-749 ◽  
Author(s):  
Chukwuweike U. Gwam ◽  
Assem Sultan ◽  
Samuel Rosas ◽  
Rashad Sullivan ◽  
Michael Seem ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Demographic Variables ◽  
Perioperative Outcomes ◽  
Patient Specific ◽  
Matched Cohort ◽  
Improvement Program ◽  
Surgical Quality ◽  
Lengths Of Stay ◽  
Increased Risk ◽  
Discharge Status

AbstractWith a growing prevalence for chronic renal failure, arthroplasty surgeons will find it more likely to have dialysis dependent patients present for knee replacement. Previous retrospective studies using a matched cohort of patients have reported worse perioperative outcomes for dialysis-dependent patients. However, many of these studies failed to control for pertinent confounders. This study aims to fill in that void. The present study compares lengths of stay, discharge status, and 30-day outcomes between dialysis-dependent TKA recipients and a matched cohort of nondialysis dependent TKA recipients. The National Surgical Quality Improvement Program database was used to identify the study cohorts. Patients were propensity score matched based on patient-specific demographic variables, preoperative functional status, and preoperative laboratory values. Generalized regression models were conducted to assess the effects of dialysis dependency on perioperative outcomes. Dialysis dependent patients demonstrated longer mean lengths of stay (+1.14) and a lower likelihood for home discharge (odds ratio [OR] = 0.503). There was no increased risk of 30-day complications in dialysis dependent TKA patients. Our findings demonstrate no increased risk of 30-day complications after TKA when adjusting for pertinent confounders. This suggests TKA is safe for well optimized dialysis dependent patients prior to surgery.

Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome

2021 ◽  
pp. 155633162110148
Author(s):  
Philipp Gerner ◽  
Stavros G. Memtsoudis ◽  
Crispiana Cozowicz ◽  
Ottokar Stundner ◽  
Mark Figgie ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Selection Criteria ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Cardiac Complications ◽  
Complication Rates ◽  
Major Complications ◽  
Increased Risk ◽  
Comorbidity Burden ◽  
Rate Ratios

Background: Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose: We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods: In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998–2006) and those who underwent surgery after (2007–2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results: Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion: After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.

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.

The Impact of Glycemic Control and Diabetes Mellitus on Perioperative Outcomes After Total Joint Arthroplasty

2009 ◽  
Vol 91 (7) ◽  
pp. 1621-1629 ◽  
Author(s):  
Milford H Marchant ◽  
Nicholas A Viens ◽  
Chad Cook ◽  
Thomas Parker Vail ◽  
Michael P Bolognesi
Keyword(s):  
Diabetes Mellitus ◽  
Glycemic Control ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Perioperative Outcomes ◽  
The Impact

Does the Timing of the Second Surgery of a Staged Bilateral Total Joint Arthroplasty Affect the Rate of Hospital Adverse Events and Perioperative Outcomes?

2020 ◽  
Vol 35 (6) ◽  
pp. 1516-1520
Author(s):  
Jesus M. Villa ◽  
Tejbir S. Pannu ◽  
Carlos A. Higuera ◽  
Juan C. Suarez ◽  
Preetesh D. Patel ◽  
...  
Keyword(s):  
Adverse Events ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Perioperative Outcomes ◽  
Second Surgery

Insulin-Dependent Diabetic Patients are at Increased Risk of Postoperative Hyperglycemia When Undergoing Total Joint Arthroplasty

2020 ◽  
Vol 35 (9) ◽  
pp. 2375-2379
Author(s):  
Brian M. Godshaw ◽  
Michael S. Warren ◽  
Michael A. Nammour ◽  
George F. Chimento ◽  
Alaa E. Mohammed ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Insulin Dependent ◽  
Insulin Dependent Diabetic

Same-day and delayed hospital discharge are associated with worse outcomes following total knee arthroplasty

2019 ◽  
Vol 101-B (7_Supple_C) ◽  
pp. 70-76 ◽  
Author(s):  
L. L. Nowak ◽  
E. H. Schemitsch
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Matched Cohort ◽  
Improvement Program ◽  
Surgical Quality ◽  
Increased Risk ◽  
American College Of Surgeons ◽  
Multivariable Regression ◽  
Total Knee

Aims To evaluate the influence of discharge timing on 30-day complications following total knee arthroplasty (TKA). Patients and Methods We identified patients aged 18 years or older who underwent TKA between 2005 and 2016 from the American College of Surgeons’ National Surgical Quality Improvement Program (NSQIP) database. We propensity score-matched length-of-stay (LOS) groups using all relevant covariables. We used multivariable regression to determine if the rate of complications and re-admissions differed depending on LOS. Results Our matched cohort consisted of 76 246 TKA patients (mean age 67 years (sd 9)). Patients whose LOS was zero and four days had an increased risk of major complications by an odds ratio (OR) of 1.8 (95% confidence interval (CI) 1.0 to 3.2) and 1.5 (95% CI 1.2 to 1.7), respectively, compared with patients whose LOS was two days. Patients whose LOS was zero, three, and four days had an increased risk of minor complications (OR 1.8 (95% CI 1.3 to 2.7), 1.2 (95% CI 1.0 to 1.4), and 1.6 (95% CI 1.4 to 1.9), respectively), compared with patients whose LOS was two days. In addition, a LOS of three days increased the risk of re-admission by an OR of 1.2 (95% CI 1.0 to 1.3), and a LOS of four days increased the risk of re-admission by an OR of 1.5 (95% CI 1.3 to 1.6), compared with a LOS of two days. Conclusion Patients discharged on days one to two postoperatively following TKA appear to have reduced major and minor complications compared with discharge on the day of surgery, or on days three to four. Prospective clinical data are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B(7 Supple C):70–76

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