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

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.

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

Annals of Pharmacotherapy ◽

10.1177/1060028019876077 ◽

2019 ◽

Vol 54 (2) ◽

pp. 138-143 ◽

Cited By ~ 1

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.

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

Journal of Clinical Orthopaedics and Trauma ◽

10.1016/j.jcot.2019.05.007 ◽

2020 ◽

Vol 11 (1) ◽

pp. 122-128 ◽

Cited By ~ 3

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

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Does Psychological Health Influence Hospital Length of Stay Following Total Knee Arthroplasty? A Systematic Review

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2018.03.020 ◽

2018 ◽

Vol 99 (12) ◽

pp. 2583-2594 ◽

Cited By ~ 10

Author(s):

Marie K. March ◽

Alison R. Harmer ◽

Sarah Dennis

Keyword(s):

Systematic Review ◽

Total Knee Arthroplasty ◽

Length Of Stay ◽

Knee Arthroplasty ◽

Psychological Health ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Total Knee

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Different Doses of Intravenous Tranexamic Acid in Revision Total Knee Arthroplasty: A Retrospective Study

The Journal of Knee Surgery ◽

10.1055/s-0041-1740585 ◽

2021 ◽

Author(s):

Liyile Chen ◽

Chenchen Zhao ◽

Yue Luo ◽

Qiuru Wang ◽

Qianhao Li ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Venous Thromboembolism ◽

Length Of Stay ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Revision Total Knee Arthroplasty ◽

Total Knee ◽

Revision Tka ◽

Different Doses

Abstract Purpose This article assessed the efficacy and safety of different doses of intravenous tranexamic acid (TXA) in revision total knee arthroplasty (TKA). Methods We retrospectively identified 122 patients in our institution who underwent revision TKA with a history of perioperative intravenous TXA utilization. According to the sum of intravenous TXA documented, all patients were divided into three groups: 1 g intravenous TXA, 2 g intravenous TXA, and equal or greater than 3 g intravenous TXA. The primary outcomes included total blood loss (TBL), hidden blood loss (HBL), transfusion rate, and the incidence of symptomatic venous thromboembolism among the three groups. A correlation analysis was conducted to analyze the correlation between the dose of TXA and the blood loss. Results In total, there was no significance difference in TBL and revised HBL (rHBL) between the first two groups (1 g/dL for intravenous TXA, 2 g/dL for intravenous TXA; p = 0.486; p = 0.525). Equal or greater than 3 g intravenous TXA (≥3 g/dL for intravenous TXA) reached a significant reduction in TBL, rHBL, and length of stay compared with the first two groups (p = 0.01; p = 0.01; p = 0.01). The rate of transfusion between the three groups did not differ significantly (p = 0.21). Due to the limitations in sample size, only one symptomatic venous thromboembolism was reported in the 1 g intravenous TXA group. Conclusion Applying the dose of intravenous TXA equal or greater than 3 g in revision TKA might further reduce the blood loss and shorten the length of stay.

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