scholarly journals The Risk Factors and Predictive Nomogram for Length Of Stay More than 14 Days in Undergoing TKA Patients: A Secondary Analysis Based on a Cohort Study in Singapore

2021 ◽  
Author(s):  
Bo Liu ◽  
Yijiang Ma ◽  
Chunxiao Zhou ◽  
zhijie wang
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Secondary Analysis ◽  
Lasso Regression ◽  
Total Knee ◽  
Operation Duration

Abstract Objective: The aim was to explore the risk factors and establish a predictive nomogram of length of stay (LOS) more than 14 days in a undergoing Total knee arthroplasty (TKA) cohort .Methods: We used the raw data, a retrospective cohort study of 2622 patients undergoing TKA in Singapore, for secondary analysis. The LASSO regression was used to optimize feature selection for the LOS more than 14 days. The Multivariable logistic regression analysis was applied to build a predicting nomogram by using the feature selected in the LASSO regression model. In order to evaluate the prediction ability of the model, we calculated the C-index. Simultaneously, the ROC curve, the Calibration curve and the DCA curve was draw to assess the model. Finally, we used 1000 times bootstrap method to verify the accuracy of the model. Results: Finally, 100(3.81%) patients were hospitalized for more than 14 days and 2522 patients (96.19%) were less 14 days. Patient age, ASA status, type of anesthesia, operation duration, procedure description, DM, IHD, CHF, day of operation and blood transfusion were determined and incorporated into the diagnostic nomogram. The C-index was 0.797(95% CI: 0.755-0.839).The calibration curve showed that the model had good recognition ability.The DCA curve analysis showed that the risk nomogram of length of stay more than 14 days was clinically useful.The C-index is 0.763 through 1000 times bootstrapping validation.Conclusion:We used the age, ASA status, type of anesthesia, operation duration, procedure description, DM, IHD, CHF, day of operation and blood transfusion to establish the clinical prediction model , this method can conveniently predict the risk of individual patients with total knee arthroplasty length of stay for more than 14 days.

scholarly journals Early Pulmonary Complications following Total Knee Arthroplasty under General Anesthesia: A Prospective Cohort Study Using CT Scan

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kai Song ◽  
Zhen Rong ◽  
Xianfeng Yang ◽  
Yao Yao ◽  
Yeshuai Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Cohort Study ◽  
Pleural Effusion ◽  
Blood Transfusion ◽  
Ct Scan ◽  
Knee Arthroplasty ◽  
Prospective Cohort ◽  
Pulmonary Complications ◽  
Total Knee

Purpose.Postoperative pulmonary complications (PPCs) are common after major surgeries. However, the number of studies regarding PPCs following total knee arthroplasty (TKA) is limited. The aim of this study was to determine the incidence of early PPCs following TKA by computed tomography (CT) scan and to identify associated risk factors.Methods.Patients, who were diagnosed with osteoarthritis or rheumatoid arthritis and underwent primary TKA at our institution, were included in this prospective cohort study. Patients received a standard procedure of TKA under general anesthesia. Chest CT scan was performed during 5–7 days postoperatively. Univariate analysis and multivariate logistic regression analysis were employed to identify the risk factors.Results.The total incidence of early PPCs following TKA was 45.9%. Rates of pneumonia, pleural effusion, and atelectasis were 14.4%, 38.7%, and 12.6%, respectively. Lower body mass index and perioperative blood transfusion were independent risk factors for PPCs as a whole and associated with atelectasis. Postoperative acute episode of hypoxemia increased the risk of pneumonia. Blood transfusion alone was related to pleural effusion.Conclusions.The incidence of early PPCs following TKA was high. For patients with relevant risk factors, positive measures should be adopted to prevent PPCs.

Association between Type of Anesthesia and Risk of Blood Transfusion Events in Primary Unilateral Total Knee Arthroplasty: A Secondary Analysis Based on a Cohort Study in Singapore

2020 ◽  
Author(s):  
Zhongxin Zhu ◽  
Peijian Tong
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Cohort Study ◽  
Blood Transfusion ◽  
Knee Arthroplasty ◽  
Secondary Analysis ◽  
Operation Time ◽  
Multivariable Logistic Regression Analysis ◽  
Logistic Regression Models ◽  
Total Knee

AbstractThis study evaluated whether the type of anesthesia independently related to risk of blood transfusion events in patients undergoing total knee arthroplasty (TKA) after adjusting for other covariates. This was a secondary analysis of a retrospective cohort study of patients undergoing primary unilateral TKA in Singapore. The independent variable was the type of anesthesia and the dependent variable was blood transfusion events. A multivariable logistic regression analysis was performed adjusting for variables that might affect the choice of anesthesia or blood transfusion events. Additional analyses examined this association by the subgroup analysis by using stratified multivariate logistic regression models. Of all 2,366 patients undergoing primary unilateral TKA, 120 (5.1%) developed blood transfusion events. Sixty-four (4.1%) of 1,560 patients with regional anesthesia (RA) developed blood transfusion events, compared with 56 (6.9%) of 806 patients with general anesthesia (GA; (p = 0.003). After adjusting for age, sex, preoperative hemoglobin, and other variables, patients who received RA had a decreased risk of blood transfusion events compared with those receiving GA (odds ratio [OR]: 0.53, 95% confidence interval [CI]: 0.35–0.81). This risk further decreased in male (OR: 0.20, 95% CI: 0.07–0.59) and participants whose operation time ≥ 90 minutes (OR: 0.39, 95% CI: 0.19–0.78). Our results indicated that patients receiving primary unilateral TKA who were managed with RA had a significantly decreased risk of blood transfusion events compared with those with GA, especially in male and participants whose operation time ≥ 90 minutes.

scholarly journals Association Between Operation Duration of Total Knee Arthroplasty and Risk of Blood Transfusion Events: A Secondary Analysis Based on Cohort Study in Singapore

2021 ◽  
Author(s):  
Bo Liu ◽  
Yue He ◽  
Junpeng Pan ◽  
Zhijie Wang
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Blood Transfusion ◽  
Secondary Analysis ◽  
Perioperative Period ◽  
Multivariable Logistic Regression Analysis ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
Total Knee ◽  
Operation Duration

Abstract BackgroundThe purpose of our research is to explore the association between operation duration and the risk of blood transfusion in the patients undergoing TKA.MethodsThis study was a secondary analysis based on the data of a single-center retrospective cohort study in Singapore. The independent variable was the operation duration, and the dependent variable was the risk of blood transfusion events in the perioperation. we analyzed the risk factors of blood transfusion in the Perioperative period by univariate logistic regression, then, multivariable logistic regression analysis was performed adjusting for variables that might affect the operation duration of TKA and the risk of blood transfusion events. Additional analyses examined this association by the subgroup analysis by using stratified multivariate logistic regression models.ResultsAmong 2,622 patients, 153 (5.8%) had blood transfusion in perioperative period. The older (OR=1.051 ,95% CI:1.030, 1.073), the lower BMI (OR=0.939,95% CI: 0.903,0.976),the lower Hb (OR=0.603,95% CI: 0.541 6.132), the DM on insulin (OR=2.542,95%CI:1.054, 6.132), the Bilateral TKA(OR=3.202, 95%CI:2.087, 4.913), the within CHF (OR=4.600, 95% CI :1.685, 12.563), the Cr≥2mg/dl (OR=7.246, 95% CI:2.739, 19.166), the higher ASA status (OR=6.439, 95% CI:2.403, 17.249), the higher risk of blood transfusion (P<0.05).The operation duration was positively correlated with perioperative blood transfusion. We demonstrated that the risk of blood transfusion increased by 1.1% for 1-minute increase in operation duration (OR = 1.011,95% CI: 1.004,1.018). ConclusionOur research shows that the longer the TKA operation duration, the higher the incidence of blood transfusion. The risk of blood transfusion events increases by 66% for every 1-hour increase in operation duration. Compared with patients with operation duration＜100 minutes, patients with operation duration more than 100 minutes have an increased risk of blood transfusion events by 56.8%.

scholarly journals Does blood transfusion type affect complication and length of stay following same-day bilateral total knee arthroplasty?

2018 ◽  
Vol 15 (2) ◽  
pp. 308-312 ◽  
Author(s):  
Vasileios G. Soranoglou ◽  
Lazaros A. Poultsides ◽  
Florian Wanivenhaus ◽  
Allina A. Nocon ◽  
Georgios K. Triantafyllopoulos ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Bilateral Total Knee Arthroplasty ◽  
Total Knee

scholarly journals Two types of anaesthesia and length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA): a secondary analysis based on a single-centre retrospective cohort study in Singapore

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xuan JI ◽  
Weiqi KE
Keyword(s):  
Total Knee Arthroplasty ◽  
Logistic Regression ◽  
Cohort Study ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Subgroup Analysis ◽  
Length Of Hospital Stay ◽  
Total Knee ◽  
Type Of Anaesthesia

Abstract Background Evidence regarding the relationship between the type of anaesthesia and length of hospital stay is controversial. Therefore, the objective of this research was to investigate whether the type of anaesthesia was independently related to the length of hospital stay in patients undergoing unilateral total knee arthroplasty (TKA) after adjusting for other covariates. Methods The present study was a cohort study. A total of 2622 participants underwent total knee arthroplasty (TKA) at a hospital in Singapore from 2013 to 1-1 to 2014-6-30. The target independent variable and the dependent variable were two types of anaesthesia and length of hospital stay, respectively. The covariates included age, BMI, hemoglobin (Hb), length of stay (LOS), duration of surgery, sex, ethnicity, American Society of Anesthesiologist (ASA) Status, smoking, obstructive sleep apnea (OSA), diabetes mellitus (DM), DM on insulin, ischemic heart disease (IHD), congestive cardiac failure (CCF), cerebrovascular accident (CVA), creatinine > 2 mg/dl, day of week of operation. Multivariate linear and logistic regression analyses were performed on the variables that might influence the choice of the two types of anaesthesia and the LOS. This association was then tested by subgroup analysis using hierarchical variables. Results The average age of 2366 selected participants was 66.57 ± 8.23 years old, and approximately 24.18% of them were male. The average LOS of all enrolled patients was 5.37 ± 4.87 days, 5.92 ± 6.20 days for patients receiving general anaesthesia (GA) and 5.09 ± 3.98 days for patients receiving regional anaesthesia (RA), P < 0.05. The results of fully adjusted linear regression showed that GA lasted 0.93 days longer than RA (β = 0.93, 95% CI (0.54, 1.32)), P < 0.05. The results of fully adjusted logistic regression showed that LOS > 6 days was 45% higher for GA than for RA (OR = 1.45, 95% CI (1.15, 1.84)), P < 0.05. Through the subgroup analysis, the results were basically stable and reliable. Conclusion Our study showed that GA increased the length of stay during unilateral TKA compared with RA. This finding needs to be validated in future studies.

scholarly journals Procedure-Related Risk Factors May Be More Important in Predicting Length of Stay After Total Knee Arthroplasty

2019 ◽  
Vol 101 (12) ◽  
pp. e59
Author(s):  
Ronald E. Delanois ◽  
Jaydev B. Mistry ◽  
Jennifer I. Etcheson ◽  
Chukwuweike U. Gwam
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Related Risk ◽  
Total Knee

scholarly journals Sarcopenia is an Independent Risk Factor for Postoperative Blood Transfusion in Total Knee Arthroplasty: A Retrospective, Propensity Score-Matched Cohort Study

2022 ◽  
Author(s):  
Doohyun Hwang ◽  
Hyuk-Soo Han ◽  
Myung Chul Lee ◽  
Du Hyun Ro
Keyword(s):  
Skeletal Muscle ◽  
Total Knee Arthroplasty ◽  
Risk Factor ◽  
Cohort Study ◽  
Blood Transfusion ◽  
Propensity Score ◽  
Knee Arthroplasty ◽  
Retrospective Cohort ◽  
Independent Risk Factor ◽  
Total Knee

Abstract Background: Sarcopenia, an age-related loss of skeletal muscle mass and function, is correlated with adverse outcomes after some surgeries. This study examined the incidence and characteristics of sarcopenic patients undergoing primary total knee arthroplasty (TKA), and identified sarcopenia as an independent risk factor for postoperative TKA complications.Methods: A retrospective cohort study examined 452 patients who underwent TKA. The skeletal muscle index (SMI) was obtained via bioelectrical impedance analysis (BIA), along with demographics, the Charlson Comorbidity Index, and medication, laboratory and operative data for 2018–2021. Patients were categorized into non-sarcopenia (n = 417) and sarcopenia (n = 35) groups using the SMI cut-off suggested by the Asian Working Group for Sarcopenia 2019 (males, < 7.0 kg/m2; females, < 5.7 kg/m2). Three postoperative complications were analyzed: blood transfusion, delirium, and acute kidney injury (AKI). Baseline characteristics were propensity score-matched to address potential bias and confounding factors.Results: The incidence of sarcopenia in primary TKA was 7.7% (35/452). The sarcopenia group had a lower preoperative hemoglobin (12.18±1.20 vs. 13.04±1.73 g/dL, p=0.004) and total protein (6.73±0.42 vs. 7.06±0.44 mg/dL, p=0.001). Propensity scoring matching and logistic regression showed that more patients in the sarcopenia group received postoperative blood transfusions (OR = 6.60, 95% CI: 1.57–45.5, p=0.021); there was no significant difference in AKI or delirium. Univariate receiver operating characteristic curve analysis of the propensity-matched group, to determine the predictive value of SMI for postoperative transfusion, gave an AUC of 0.797 (0.633–0.96) and SMI cut-off of 5.6 kg/m2.Conclusions: Sarcopenia determined by BIA was an independent risk factor for postoperative transfusion in TKA. Multifrequency BIA can serve as a screening tool for sarcopenia. Orthopedic surgeons should be aware of this, as it could influence the decision-making process or treatment plan of patients with sarcopenia undergoing primary TKA.Level of evidence: III, retrospective cohort study

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