scholarly journals The safety and cost-analysis of simultaneous versus staged bilateral total knee arthroplasty in a Taiwan population

2022 ◽  
Author(s):  
Te-Feng Arthur Chou ◽  
Hsuan-Hsiao Ma ◽  
Yu-Chun Hsu ◽  
Chi-Wu Tsai ◽  
Shang-Wen Tsai ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Reoperation Rate ◽  
Transfusion Rate ◽  
Complication Rates ◽  
Net Income ◽  
Level Of Evidence ◽  
Total Knee ◽  
The Cost ◽  
Reoperation Rates ◽  
Simultaneous Bilateral Tka

Abstract The purpose of this study was to investigate the safety of Simultaneous, bilateral TKA (SiTKA). Furthermore, we also assessed the cost reduction of SiTKA in comparison with Staged, bilateral TKA (StTKA). We retrospectively review all patients that underwent SiTKA or StTKA due to osteoarthritis (OA) or spontaneous osteonecrosis of the knee (SONK).We assessed length of stay, transfusion rate, early postoperative complications, 30-day and 90-day readmission rate, 1-year reoperation rate and the indication for reoperation. Furthermore, we analyzed the total cost of the two groups, reimbursement from the national health insurance (NHI), cost of the procedures, and net income from each case. A total of 2016 patients (1565 SiTKA and 451 StTKAs) were included in this study. There were no significant differences in terms of complication rates, 30-day and 90-day readmission, and 1-year reoperations between the two groups. The total length of stay was on average 5.0 days longer for StTKA (p<0.01). In terms of cost, all categories of medical costs were significantly lower in SiTKA, while the net hospital income was significantly higher for StTKA. In conclusion, SiTKA and StTKA have similar postoperative complication, readmission and reoperation rates, while SiTKA significantly reduces medical expenses for the patient and NHI. Level of evidence: level III, retrospective cohort study

Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis

Cartilage ◽  
2021 ◽  
pp. 194760352110115
Author(s):  
Jacob G. Calcei ◽  
Kunal Varshneya ◽  
Kyle R. Sochacki ◽  
Marc R. Safran ◽  
Geoffrey D. Abrams ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Reoperation Rate ◽  
Similar Rate ◽  
Osteochondral Allograft ◽  
Complication Rates ◽  
Cartilage Restoration ◽  
Chondrocyte Implantation ◽  
The Cost ◽  
Reoperation Rates

Objective The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy. Study Design Retrospective cohort study, level III. Design Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated. Results A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively. Conclusions Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.

scholarly journals Tourniquet use in routine primary total knee arthroplasty is associated with a higher transfusion rate and longer postoperative length of stay: a real-world study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Xu ◽  
Jingli Yang ◽  
Jinwei Xie ◽  
Zeyu Huang ◽  
Qiang Huang ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Length Of Stay ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Primary Total Knee Arthroplasty ◽  
Transfusion Rate ◽  
Partial Regression Coefficient ◽  
Postoperative Length ◽  
Total Knee ◽  
The Impact

Abstract Background In an enhanced recovery after surgery program, a growing number of orthopedists are reconsidering the necessity of tourniquet use in total knee arthroplasty (TKA). However, the impact of tourniquet use on transfusion rate and postoperative length of stay (PLOS) in TKA remains controversial. Therefore, we carried out a study to investigate the effect of tourniquet application in routine primary TKA on transfusion rate and PLOS. Methods We analyzed data from 6325 patients who underwent primary unilateral TKA and divided them into two groups according to whether a tourniquet was applied during the procedure, and a tourniquet was used in 4902 and not used in 1423. The information for transfusion and PLOS was extracted from patients’ electronic health records, and the data were analyzed with logistic and linear regression analyses. Results Following TKA, the transfusion rate and PLOS were 14.52% and 7.72 ± 3.54 days, respectively, in the tourniquet group, and 6.47% and 6.44 ± 3.48 days, respectively, in the no-tourniquet group. After adjusting for the different related variables, tourniquet use was significantly correlated with a higher transfusion rate (risk ratio = 1.888, 95% confidence interval (CI) 1.449–2.461, P < 0.001) and a longer PLOS (partial regression coefficient (B) = 0.923, 95%CI 0.690–1.156, P < 0.001). Conclusions Our findings suggested that tourniquet use in routine primary TKA was related to a higher transfusion rate and a longer PLOS. The impact of tourniquet use on transfusion rate and PLOS should be taken into account in clinical practice.

One-Stage Augmentation Mastopexy: A Retrospective Ten-Year Review of 2183 Consecutive Procedures

2019 ◽  
Vol 39 (12) ◽  
pp. 1352-1367 ◽  
Author(s):  
Charles A Messa ◽  
Charles A Messa
Keyword(s):  
Complication Rate ◽  
Capsular Contracture ◽  
Skin Flap ◽  
Reoperation Rate ◽  
Related Complication ◽  
Level Of Evidence ◽  
One Stage ◽  
Reoperation Rates ◽  
Augmentation Mastopexy

AbstractBackgroundAlthough numerous studies supporting breast augmentation with simultaneous mastopexy have been reported, concerns persist among surgeons regarding the safety of this procedure.ObjectivesThe authors sought to evaluate the safety and effectiveness of 1-stage augmentation mastopexy by analyzing long-term complication and reoperation rates.MethodsThe authors conducted a retrospective review of 1131 patients who underwent 2183 consecutive 1-stage augmentation mastopexy procedures from January 2006 to August 2016. Patient demographics, operative technique, and implant specifications were measured and analyzed with surgical outcomes. Long-term complication and reoperation rates were noted.ResultsOver a mean follow-up period of 43 months (range, 4-121 months), the overall complication rate was 15.3% (n = 173) with a reoperation rate of 14.7% (n = 166). Tissue-related complications included hypertrophic scarring in 2.5% (n = 28) and recurrent ptosis in 2.1% (n = 24). The most common implant-related complication was capsular contracture (Baker III or IV) in 2.8% (n = 32). The most common indications for reoperation were recurrent ptosis in 3.5% (n = 40 patients) and desire to change implant size in 3.2% (n = 36 patients). Circumareolar augmentation mastopexy technique was associated with a higher reoperation rate of 25.7% (P < 0.0005). Patients with a history of smoking had a higher incidence of complications (26.1%) and reoperations (22.5%; P < 0.0005). There were no cases of significant skin flap necrosis (>2 cm).ConclusionsOne-stage augmentation mastopexy can be safely performed with a reoperation rate that is significantly lower than when the procedure is staged. The effectiveness of this procedure is defined by a low complication rate and a reduced number of operations for the patient.Level of Evidence: 4

scholarly journals Enhanced Recovery Protocol Reduces Transfusion Requirements and Hospital Stay in Patients Undergoing an Elective Arthroplasty Procedure

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Kirsten Juliette de Burlet ◽  
James Widnall ◽  
Cefin Barton ◽  
Veera Gudimetla ◽  
Stephen Duckett
Keyword(s):  
Length Of Stay ◽  
Enhanced Recovery ◽  
Transfusion Rate ◽  
Transfusion Requirements ◽  
Total Knee ◽  
Enhanced Recovery Protocol ◽  
Knee Arthroplasty Surgery ◽  
The Impact ◽  
Arthroplasty Surgery ◽  
Arthroplasty Procedure

Background. Enhanced recovery (ER) for elective total hip or total knee replacement has become common practice. The aim of this study is to evaluate the impact of ER on transfusion rates and incidence of venous thromboembolism (VTE). Methods. A comprehensive review was undertaken of all patients who underwent primary hip or knee arthroplasty surgery electively between January 2011 and December 2013 at our institution. ER was implemented in August 2012, thus creating two cohorts: the traditional protocol (TP) group and the ER group. Outcome measurements of length of stay, postoperative transfusion, thromboembolic complications, and number of readmissions were assessed. Main Findings. 1262 patients were included. The TP group contained a total of 632 patients and the ER group contained 630 patients. Postoperative transfusion rate in the ER group was reduced with 45% (P≤0.05). There was no statistical difference in postoperative VTE complications. The length of stay was reduced from 5.5 days to 4.8 days (P<0.05). Conclusions. There was no difference in the number of readmissions. ER has contributed to a significant decrease in transfusions after elective arthroplasty surgery, with no increase in the incidence of thromboembolic events. Furthermore, it has significantly reduced inpatient length of stay.

scholarly journals Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013

2017 ◽  
Vol 99 (5) ◽  
pp. 402-407 ◽  
Author(s):  
Ilda B. Molloy ◽  
Brook I. Martin ◽  
Wayne E. Moschetti ◽  
David S. Jevsevar
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Total Knee ◽  
The Cost

scholarly journals Bilateral Sequential Total Knee Replacement versus Unilateral Total Knee Replacement in a High Volume Hospital

2018 ◽  
Vol 24 (1) ◽  
pp. 9-11
Author(s):  
Chan Calvin Pui-kan ◽  
Lee Quun-jid ◽  
Wong Yiu-chung ◽  
Wai Yuk-leung
Keyword(s):  
Total Knee Replacement ◽  
Knee Replacement ◽  
Total Joint Replacement ◽  
Major Complication ◽  
High Volume ◽  
Transfusion Rate ◽  
Complication Rates ◽  
High Volume Hospital ◽  
Total Knee ◽  
Acute Retention

Background/Purpose Bilateral simultaneous or sequential total knee replacement (TKR) is performed on a portion of patients but the benefits and risks remain controversial. Methods A total of 89 sequential bilateral TKR (BTKR) patients were compared with 89 unilateral TKR (UTKR) patients in our total joint replacement centre from October 2011 to October 2014. The baseline parameters were matched and postoperative results were compared. Results The BTKR group had a shorter length of stay per knee (4.8 days vs. 6.5 days) but with a higher total drain output, higher haemoglobin drop, higher transfusion rate, and more postoperative acute retention of urine. Both groups had similar major complication rates and no 90 days mortality. Conclusion BTKR is a safe surgery in selected patients performed in a high volume hospital with fast-track programme.

scholarly journals Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis

Cartilage ◽  
2020 ◽  
pp. 194760352096706
Author(s):  
Kyle R. Sochacki ◽  
Kunal Varshneya ◽  
Jacob G. Calcei ◽  
Marc R. Safran ◽  
Geoffrey D. Abrams ◽  
...  
Keyword(s):  
Autologous Chondrocyte Implantation ◽  
Reoperation Rate ◽  
Osteochondral Allograft ◽  
Complication Rates ◽  
Allograft Transplantation ◽  
Chondrocyte Implantation ◽  
Reoperation Rates ◽  
Insurance Database ◽  
Autologous Chondrocyte

Objective To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database. Design Subjects who underwent knee ACI (Current Procedural Terminology [CPT] code 27412) or OCA (CPT code 27415) with minimum 2-year follow-up were queried from a national insurance database. Reoperation was defined by ipsilateral knee procedure after index surgery. Multivariate logistic regression models were built to determine the effect of independent variables (age, sex, tobacco use, obesity, diabetes, and concomitant osteotomy) on reoperation rates. The 30-day complication rates were assessed using ICD-9-CM codes. The cost of the procedures per patient was calculated. Statistical comparisons were made. All P values were reported with significance set at P < 0.05. Results A total of 909 subjects (315 ACI and 594 OCA) were included (mean follow-up 39.2 months). There was a significantly higher reoperation rate after index ACI compared with OCA (67.6% vs. 40.4%, P < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, P < 0.0001 and OR 0.2, P = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups ( P = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA ( P = 0.013). Conclusions Autologous chondrocyte implantation had significantly higher reoperation rates and cost with similar complication rates compared with OCA. Concomitant osteotomy significantly reduced the risk for reoperation in both groups.

scholarly journals A Comparison of Cost and Complications of Total Ankle Arthroplasty and Ankle Arthrodesis for the Management of Ankle Arthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0049
Author(s):  
William Tucker ◽  
Bandon Barnds ◽  
Scott Mullen ◽  
Paul Schroeppel ◽  
Bryan Vopat
Keyword(s):  
Large Scale ◽  
Statistical Significance ◽  
Disease Process ◽  
Ankle Arthrodesis ◽  
Reoperation Rate ◽  
Complication Rates ◽  
Ankle Arthritis ◽  
Patient Health ◽  
Initial Procedure ◽  
Reoperation Rates

Category: Ankle Arthritis Introduction/Purpose: Ankle arthritis is a relatively common ailment that affects many people. The method of surgical management of this disease process is usually an ankle arthrodesis (AA) or a total ankle replacement (TAR). Traditionally, AA was viewed as the “gold standard”, however TAR has grown in popularity. Numerous studies have evaluated the risks and benefits of each of these treatments including satisfaction, biomechanics, and cost. The purpose of this study was to compare the cost and rate of complications for patients who underwent either an AA or TAR using a large database. Methods: Using the PearlDiver Technologies, Inc. database, Medicare patients who were diagnosed with ankle arthritis based on ICD-9 codes from 2005 to 2014 were analyzed. Patients were identified who underwent either AA or TAR utilizing ICD-9 procedure and CPT codes. These patient groups were evaluated for postoperative complications and reoperation rates. Subjects and associated costs were followed after the initial procedure. A cost analysis based on diagnosis and procedural codes was then performed on the separate groups, using a t-test to determine statistical significance. Data was analyzed with regards to standard demographic information as well as a metric of overall patient health status, the Charlson Comorbidity Index (CCI). Results: During the study period, 673,789 patients were identified with the diagnosis of ankle arthritis. Of those, 19,120(2.8%) underwent AA and 9,059 (1.3%) underwent TAR. While the yearly rate of AA performed remained stable, TAR was performed at increasing rates. The overall complication rate in the AA group was 24.9% with a 16.5% revision rate compared to 15.1% and 11.2% respectively in the TAR group (P<0.001). Also, the AA group had a higher total reoperation rate. The CCI was found to be significantly lower in the TAR group at 4.5 versus 4.7 in AA patients (P<0.001). Patients younger than 65 years old had both higher complication and reoperation rate. The average one-year cost associated with TAR was $12,566.15 and with AA was $6,967.32 (P<0.001). Conclusion: While TAR was found to be a more expensive treatment option than AA in this large-scale database study, patients in this group had significantly lower complication rates. The reoperation rates were also lower in the TAR group. The CCI was noted to be slightly lower in the arthroplasty group, meaning these patients may have been healthier, representing a selection bias. Also, the patients that had complications were found to have a higher CCI on average. When choosing surgical intervention for end-stage ankle arthritis, patients should be counseled on cost differences and potential complications for TAR and AA.

Emergent urinary decompression in acute stone-related urinary obstruction: A systematic review and meta-analysis

2021 ◽  
pp. 205141582110170
Author(s):  
David Eugenio Hinojosa-Gonzalez ◽  
Mauricio Torres-Martinez ◽  
Sergio Uriel Villegas-De Leon ◽  
Cecilia Galindo-Garza ◽  
Andres Roblesgil-Medrano ◽  
...  
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Operative Time ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Percutaneous Nephrostomy ◽  
Complication Rates ◽  
Success Rates ◽  
Level Of Evidence ◽  
Cell Counts

Introduction: Emergent urinary decompression through percutaneous nephrostomy (PCN) or ureteric stent (URS) remains a mainstay in the management of urethral calculi-related obstruction with associated signs of infection or renal injury. Available evidence has shown similar performance, and current guidelines endorse both treatment strategies. Methods: A systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria up until August 2020. Studies included data on stone size and location, operative time, complications, length of stay, analgesic consumption, quality of life (QoL), and clinical outcomes between URS and PCN. Results: Ten studies with a total population of 772, of which 420 were treated with URS and 352 with PCN, were included. No statistical difference in operative time between both techniques was found. Nevertheless, length of stay in PCN was longer than in USR, with a mean difference of −1.87 days ((95% CI −2.69 to −1.06), Z=4.50, p=0.00001). No differences were found in the time to normalization of temperature or white blood cell counts. There were no significant differences in success rates, with an overall odds ratio (OR) of 0.60 ((95% CI 0.26 to −1.40), Z=1.17, p=0.24), or spontaneous passage after emergent drainage between groups. Complication rates ranged from 5% to 25% in URS and from 0% to 38% in PCN. In the studied population, out of the 157 patients from four studies describing complications, only 5% of URS procedures presented complications compared to 2% in PCN, showing a relatively low complication rate for either group (OR=2.07 (95% CI 0.89–4.84), Z=1.68, p=0.09). Differences in QoL were not significant. Conclusion: Both methods are equally effective, with no clear advantage for PCN over URS. Level of evidence: IV

A Comparison of Complications and Reoperations Between Open Reduction and Internal Fixation Versus Primary Arthrodesis Following Lisfranc Injury

2021 ◽  
pp. 193864002110582
Author(s):  
Eric So ◽  
Jonathan Lee ◽  
Michelle L. Pershing ◽  
Anson K. Chu ◽  
Matthew Wilson ◽  
...  
Keyword(s):  
Internal Fixation ◽  
Open Reduction ◽  
Retrospective Chart Review ◽  
Reoperation Rate ◽  
Complication Rates ◽  
Lisfranc Injury ◽  
Significant Difference ◽  
Lisfranc Injuries ◽  
Reoperation Rates

There is a lack of consensus in the literature regarding optimal treatment methods for Lisfranc injuries, and recent literature has emphasized the need to compare open reduction and internal fixation (ORIF) with primary arthrodesis (PA). The purpose of the current study is to compare reoperation and complication rates between ORIF and PA following Lisfranc injury in a private, outpatient, orthopaedic practice. A retrospective chart review was performed on patients undergoing operative intervention for Lisfranc injury between January 2009 and September 2015. A total of 196 patients met the inclusion criteria (130 ORIF, 66 PA), with a mean follow-up of 61.3 and 81.7 weeks, respectively. The ORIF group had a higher reoperation rate than the PA group, due to hardware removal. When hardware removals were excluded, the reoperation rate was similar. Postsurgical complications were compared between the 2 groups with no significant difference. In conclusion, ORIF and PA had similar complication rates. When hardware removals were excluded, the reoperation rates were similar, although hardware removals were more common in the ORIF group compared with the PA group. Levels of Evidence: Level III

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