scholarly journals Prolonged surgical time increases the odds of complications following total knee arthroplasty

2021 ◽  
Vol 64 (3) ◽  
pp. E273-E279
Author(s):  
Mina W. Morcos ◽  
Lauren Nowak ◽  
Emil Schemitsch
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Major Complication ◽  
Minor Complication ◽  
Readmission Rates ◽  
Improvement Program ◽  
Surgical Time ◽  
Total Knee ◽  
A Minor

Background: The aim of this study was to evaluate the influence of operating time on complications and readmission within 30 days of total knee arthroplasty (TKA) and to determine if there were specific time intervals associated with worse outcomes. Methods: The American College of Surgeons’ National Surgical Quality Improvement Program database was used to identify patients 18 years of age and older who underwent TKA between 2006 and 2017, using procedural codes. Patient demographic characteristics, operation length and 30-day major and minor complication and readmission rates were captured. We used multivariable regression to determine if the rates of complications and readmission differed depending on the length of the operation, while adjusting for relevant covariables. Results: A total of 263 174 patients who underwent TKA were identified from the database. Their mean age was 66.8 (standard deviation 9.7) years. Within 30 days of the index procedure, 5700 patients (2.2%) experienced a major complication, 5185 (2.0%) experienced a minor complication and 7730 (3.1% of 249 746 patients from 2011 to 2017) were readmitted. Mean operation length was 91.7 minutes (range 30–240 min). After adjustment for relevant covariables, an operating time of 90 minutes or more was a significant predictor of major and minor complications as well as readmission. There was no difference in the odds of complications or readmission for operations lasting 30–49, 50–69 or 70–89 minutes (p > 0.05). Conclusion: Our data suggest that operating times of 90 minutes or more may be associated with an increase in the 30-day odds of complications and readmission following TKA. Further studies are needed to confirm our findings and determine the influence of surgical time on outcomes when there is increased case complexity.

Operative Time, Length of Stay, Short-Term Readmission, and Complications after Hinged Primary Total Knee Arthroplasty: A Propensity Score Matched Analysis

2018 ◽  
Vol 31 (10) ◽  
pp. 940-945 ◽  
Author(s):  
Nipun Sodhi ◽  
Yatindra Patel ◽  
Jaiben George ◽  
Assem Sultan ◽  
Hiba Anis ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Operating Time ◽  
Short Term ◽  
Improvement Program ◽  
Discharge Disposition ◽  
Primary Tkas ◽  
Total Knee

AbstractDespite the wide utilization of total knee arthroplasty (TKA), it can be technically challenging to perform in patients who have concomitant bone loss, ligamentous laxity, or high-grade deformity, whether in a revision situation or due to a primary pathology. Therefore, hinged knee prostheses have been developed to provide more stable fixation in these situations. The purpose of this study was to compare the short-term peri- and postoperative outcomes of patients undergoing primary TKA with and without hinged prosthesis. Specifically, we compared (1) mean operative times, (2) lengths of stay (LOS), (3) 30-day readmissions, and (4) complications. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify hinged TKAs and 99 procedures were included. They were matched in a 1:3 ratio to primary TKAs without a hinged prosthesis using propensity score matching. Operative time, LOS, discharge disposition, 30-day readmissions, and complications were compared. Adjusted odds ratios (OR) were also calculated. The operative time was significantly higher in hinged cohort compared with the nonhinged cohort (mean difference [MD] = 22 minutes; range, 10–34 minutes, p < 0.001). There were no significant differences between hinged and nonhinged TKAs with respect to LOS (MD= 0.61 days, range, –0.07–1.30 days, p = 0.080), discharge disposition (OR = 1.09, 95% confidence interval [CI], 0.66–1.84), readmissions (OR = 2.67, 95% CI, 0.84–8.24), and any complications (OR = 1.13, 95% CI, 0.55–2.19). Not surprisingly, primary TKAs with hinged prostheses had increased operative times, but had similar LOS, discharge dispositions, and 30-day rates of readmission and complications when compared with TKAs without a hinged prosthesis. One potential contributing factor to the increased operating time is that patients who receive a hinged implant tend to present with more severe deformities. It is reassuring to know that early outcomes were similar between both cohorts (although we await longer follow-up studies), and that hinged implants can be considered in these difficult to treat patients.

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.

Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care

Medical Care ◽  
2021 ◽  
Vol 60 (2) ◽  
pp. 178-186
Author(s):  
Amy K. Rosen ◽  
Erin E. Beilstein-Wedel ◽  
Alex H.S. Harris ◽  
Michael Shwartz ◽  
Megan E. Vanneman ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Community Care ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Readmission Rates ◽  
Total Knee

scholarly journals Higher body mass index is not a risk factor for in-hospital adverse outcomes following total knee arthroplasty

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901880242 ◽  
Author(s):  
Usha Gurunathan ◽  
Aaron Pym ◽  
Cameron Anderson ◽  
Amanda Marshall ◽  
Sarah L Whitehouse ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Total Knee Arthroplasty ◽  
Body Mass ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Normal Weight ◽  
Cardiac Complications ◽  
Weight Category ◽  
Obese Class ◽  
Total Knee

Purpose: To investigate the association between body mass index (BMI) and perioperative complications until hospital discharge, following primary total knee arthroplasty (TKA). Methods: This retrospective study reviewed 1665 cases of elective primary unilateral TKA performed between 2006 and 2010, from a prospective secure electronic database. Types of complications, length of operating time, and duration of hospital stay were analyzed in both adjusted (for known confounders) and unadjusted analyses. A further matched analysis was also performed. Results: In terms of overall complications, there was no statistically significant difference between the BMI categories. When individual obesity category was considered, obese 2 had the lowest odds of developing complications, both with unadjusted (odds ratio (OR): 0.61, 95% confidence interval (CI) 0.41–0.91, p < 0.015) and adjusted regression analysis (OR: 0.65, 95% CI: 0.43–0.99, p = 0.044). Compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at 66% (OR: 0.34, 95% CI: 0.21–0.55) lower (unadjusted) odds of developing cardiac complications (overall p < 0.001). With the matched analysis, compared to normal weight category, obese class 3 (≥40 kg/m2) individuals were at a 60% (OR: 0.40, 95% CI: 0.23–0.68) lower (unadjusted) odds of developing cardiac complications (overall p = 0.004). Obese 3 patients had significantly higher operating time compared with other groups ( p < 0.001). Conclusion: This study did not find a significant association between BMI and increased overall in-hospital medical or surgical complications following primary TKA. Obesity significantly increased the length of operating time.

Preoperative Hyponatremia Is Associated with Reoperation and Prolonged Length of Hospital Stay following Total Knee Arthroplasty

2018 ◽  
Vol 32 (04) ◽  
pp. 344-351 ◽  
Author(s):  
Matthew Abola ◽  
Joseph Tanenbaum ◽  
Thomas Bomberger ◽  
Derrick Knapik ◽  
Steven Fitzgerald ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Risk Factor ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Adverse Outcomes ◽  
Limited Information ◽  
Improvement Program ◽  
Prolonged Length ◽  
Total Knee

AbstractHyponatremia is a risk factor for adverse surgical outcomes, but limited information is available on the prognosis of hyponatremic patients who undergo total knee arthroplasty (TKA). The purpose of this investigation was to compare the incidence of major morbidity (MM), 30-day readmission, 30-day reoperation, and length of hospital stay (LOS) between normonatremic and hypontremic TKA patients.The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all primary TKA procedures. Hyponatremia was defined as <135 mEq/L and normonatremia as 135 to 145 mEq/L; hypernatremic patients (>145 mEq/L) were excluded. Multivariable logistic regression was used to determine the association between hyponatremia and outcomes after adjusting for demographics and comorbidities. An α level of 0.002 was used and calculated using the Bonferroni correction. Our final analysis included 88,103 patients of which 3,763 were hyponatremic and 84,340 were normonatremic preoperatively. In our multivariable models, hyponatremic patients did not have significantly higher odds of experiencing an MM (odds ratio [OR]: 1.05; 99% confidence interval [CI] 0.93–1.19) or readmission (OR: 1.12; 99% CI: 1–1.24). However, patients with hyponatremia did experience significantly greater odds for reoperation (OR: 1.24; 99% CI: 1.05–1.46) and longer hospital stay (OR: 1.15; 99% CI: 1.09–1.21). We found that hyponatremic patients undergoing TKA had increased odds of reoperation and prolonged hospital stay. Preoperative hyponatremia may be a modifiable risk factor for adverse outcomes in patients undergoing TKA, and additional prospective studies are warranted to determine whether preoperative correction of hyponatremia can prevent complications.

Factors Affecting 30-Day Mortality following Primary Elective Total Knee Arthroplasty: A Database Study of 326,157 Patients

2021 ◽  
Author(s):  
Kevin Zhai ◽  
Melissa Orr ◽  
Daniel Grits ◽  
Ahmed K. Emara ◽  
Christopher A. Rothfusz ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Mortality Rate ◽  
Knee Arthroplasty ◽  
Preoperative Diagnosis ◽  
Mortality Rates ◽  
Male Gender ◽  
Improvement Program ◽  
Patient Demographics ◽  
Comorbidity Burden ◽  
Total Knee

AbstractDespite its rarity, the risk of mortality following primary elective total knee arthroplasty (TKA) is a critical component of surgical decision-making and patient counseling. The purpose of our study was to (1) determine the overall 30-day mortality rate for unilateral primary elective TKA patients, (2) determine the 30-day mortality rates when stratified by age, comorbidities, and preoperative diagnosis, and (3) identify the distribution of (i) patient demographics, (ii) baseline comorbidities, and (iii) preoperative diagnoses between mortality and mortality-free cohorts. A total of 326,157 patients underwent primary elective TKA (2011–2018) were identified through retrospective review of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Patients were divided into 30-day mortality (n = 320) and mortality-free (n = 325,837) cohorts. Patient demographics, preoperative comorbidities, and preoperative diagnoses were compared. Age group, American Society of Anesthesiology (ASA) score, and modified Charlson Comorbidity Index (CCI) scores were normalized per 1000 and stratified by preoperative diagnosis. The overall mortality rate was 0.098%. Older age (p < 0.001) and male gender (p < 0.001) were associated with increased mortality. There was no association between mortality and race (p = 0.346) or body mass index (BMI) class (p = 0.722). All reported comorbidities except smoking status were significantly greater in the mortality cohort (p < 0.05). For ASA scores of I, II, III, and IV, the number of deaths per 1,000 were 0.16, 0.47, 1.4, and 4.4, respectively. For CCI scores of 0, 1, 2, 3, 4, and 6, mortality rates per 1,000 were 0.76, 2.1, 7.0, 11, 29, and 7.6, respectively. Mortality rates for a preoperative diagnosis of osteoarthritis (OA) versus non-OA were, respectively, 0.096% and 0.19% (p < 0.001). Increased age, male gender, increased comorbidity burden, and non-OA preoperative diagnoses are associated with higher rates of 30-day postoperative mortality. There were no significant associations between BMI or race and 30-day mortality. These findings aid in identifying of higher-risk patients, who can then receive appropriate counseling or preoperative interventions to reduce the risk of perioperative mortality.

Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

2021 ◽  
Author(s):  
Samuel J. Swiggett ◽  
Angelo Mannino ◽  
Rushabh M. Vakharia ◽  
Joseph O. Ehiorobo ◽  
Martin W. Roche ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Administrative Claims ◽  
Readmission Rates ◽  
Costs Of Care ◽  
Lengths Of Stay ◽  
Total Knee ◽  
The Impact

AbstractThe impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.

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

The Risk Factors of Postoperative Delirium after Total Knee Arthroplasty

2016 ◽  
Vol 30 (06) ◽  
pp. 600-605 ◽  
Author(s):  
Lih Wang ◽  
Sungsoo Kim ◽  
Kyungtaek Kim ◽  
Seunghyun Lee ◽  
Kyungho Lee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Operating Time ◽  
Start Time ◽  
Duration Of Hospital Stay ◽  
History Of ◽  
Total Knee ◽  
Underlying Diseases

AbstractWe investigated the results of delirium which developed after total knee arthroplasty (TKA) and the risk factors for delirium in the patients who are older than 65 years. From March 2008 to March 2012, we performed a retrospective study on 296 knees of 265 patients who were treated with TKA. They were divided into two groups: 216 patients without delirium and 49 patients diagnosed with delirium by psychiatry. We analyzed the risk factors into three categories: First, the preoperative factors including gender, age, body mass index (BMI), clinical and functional knee joint score (Knee Society Knee Score and Knee Society Function Score) and the number of underlying diseases and associations with each disease; Second, the operative factors including the anesthesia method, amount of blood loss, operating time, laboratory factors, and transfusion count; Third, the postoperative factors such as start time of walking and duration of hospital stay were analyzed. There were significant statistical difference between two groups just in age, history of dementia, cerebrovascular disease, difference of hemoglobin and albumin, start time of walking, and duration of hospital stay. The delirium after TKA delays the postoperative ambulation and extends the hospital stay, which causes functional and socioeconomic loss of patients. Therefore, the risk factors for delirium should be assessed and proper prevention and management should be conducted.

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