scholarly journals Risk Factors of Opioid use Associated with an Enhanced-Recovery Programme after Total Knee Arthroplasty

2021 ◽  
Author(s):  
Guorui Cao ◽  
Fuxing Pei
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Protective Factor ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Opioid Use ◽  
Enhanced Recovery Programme ◽  
Total Knee

Abstract Background: The relationship between total knee arthroplasty (TKA) and postoperative opioid use is poorly studied. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA.Methods: We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Multivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were recorded and compared.Results: The prevalence of opioid use after primary TKA was 23.0%. Significant risk factor were more operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and protective factor was tranexamic acid use (OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05).Conclusion: Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use. Reducing operative time and application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

scholarly journals Risk factors of opioid use associated with an enhanced-recovery programme after total knee arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Guorui Cao ◽  
Shiqi Xiang ◽  
Minglu Yang ◽  
Songtao Quan ◽  
Junna Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Protective Factor ◽  
Operative Time ◽  
Enhanced Recovery ◽  
Opioid Use ◽  
Enhanced Recovery Programme ◽  
Total Knee

Abstract Background Characterizing the impacts of postoperative opioid use on total knee arthroplasty (TKA) patients may help optimize the pain management after TKA. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA. Methods We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Themultivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were also recorded and compared. Results The prevalence of opioid use after primary TKA was 23.0%. The significant risk factor was the longer operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and the protective factor was the utilization of tranexamic acid(OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05). Conclusion Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use after TKA. Reducing operative time and the application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

scholarly journals Percutaneous intra-articular injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day after total knee arthroplasty as a component of enhanced recovery after surgery: a randomized control trial

2020 ◽  
Author(s):  
Lijia Pei ◽  
Xiaoyang Li ◽  
Yang Liu ◽  
Xuyi Wang ◽  
Hai Ding ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Visual Analog Scale Score ◽  
Drainage Tube ◽  
Control Group ◽  
Total Blood ◽  
Total Knee

Abstract Background: Intraoperative injections of ropivacaine and tranexamic acid have an increasing role as part of analgesia and haemostasis for enhanced recovery after Total Knee Arthroplasty. However, drug efficiency gradually disappears one day after surgery. Drainage tube placed for too long can cause various complications. This study evaluates whether the postoperative injections of ropivacaine, and tranexamic acid and removal of the drainage tube one day would promote recovery after TKA. Methods: A total of 80 participants were randomly assigned to two groups. One group was treated with additional intra-articular injections at 08:30 on postoperative day 1 and the removal of drainage tube simultaneously (Trial Group). Another group was dealt with no injection and removal of the drainage tube responding to the amount of drainage fluid (Control Group). The multi-drug solution included 100 mg ropivacaine, and 1 g tranexamic acid, and 10 mL saline. The primary outcomes assessed included visual analog scale score, length of hospital stay after surgery, the circumference of the knee, total blood loss volume. Results: The group that received an additional intra-articular injection of ropivacaine had a significantly lower area under the curve for visual analog scale score than the no injection group at rest (424 ± 32 compared with 515 ± 39, p = 0.003). The Trial Group can reduce the length of hospital stay after surgery over the Control Group (7.1 ± 3.1 days compared with 8.7 ± 3.2 days, p = 0.003). The group that received an additional intra-articular injection of tranexamic acid have no difference in total blood loss volume & the circumference of knee joint over the no additional intra-articular injection group (910.6 ± 385.3 mL compared with 974.8 ± 408.2 mL, p=0.47 & 38.9 ±5.4cm compared with 38.8±2.4cm，p=0.91). Conclusions: Intra-articular injection of ropivacaine, and tranexamic acid and removal of the drainage tube one day after TKA can further promote recovery after TKA. Keywords: enhanced recovery after surgery, total knee arthroplasty, tranexamic acid, ropivacaine

scholarly journals Modifiable, Postoperative Risk Factors for Delayed Discharge Following Total Knee Arthroplasty: The Influence of Hypotension and Opioid Use

2020 ◽  
Vol 35 (1) ◽  
pp. 82-88 ◽  
Author(s):  
Albert T. Anastasio ◽  
Kevin X. Farley ◽  
Scott D. Boden ◽  
Thomas L. Bradbury ◽  
Ajay Premkumar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Opioid Use ◽  
Delayed Discharge ◽  
Postoperative Risk ◽  
Total Knee

scholarly journals Influence of inpatient opioid consumption on persistent use following total knee arthroplasty

2020 ◽  
pp. rapm-2020-101582
Author(s):  
Meredith Pace ◽  
Kerri Gannon ◽  
Matthew Friedland ◽  
Gervase Spurlin ◽  
Lori Lyn Price
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Optimal Recovery ◽  
Early Postoperative Period ◽  
Opioid Consumption ◽  
Opioid Use ◽  
Increased Risk ◽  
Prescription Refill ◽  
Total Knee

BackgroundTotal knee arthroplasty (TKA) is associated with a high incidence of continued opioid use beyond the expected period of recovery. The aim of this study was to determine the influence of inpatient opioid consumption on the development of persistent use.MethodsOpioid-naïve patients undergoing primary, uncomplicated TKA were included in a prospective, observational study at a single institution. Postoperatively, opioids were prescribed by orthopedic advanced practitioners or resident physicians and administered by registered nurses. Individual inpatient prescriptions were adjusted, as needed, to facilitate optimal recovery conditions. Average hourly inpatient opioid consumption was calculated from total usage between midnight on the day of surgery until the time of hospital discharge. Persistent opioid use was defined as a prescription refill written by the orthopedic surgeon at the 6-week surgical follow-up visit. A multivariable regression model was used to identify independent risk factors associated with persistent use.ResultsA total of 351 patients were included in the analysis. Persistent opioid use was identified in 17.4% (61) of patients overall. A history of alcohol abuse (OR 7.80; 95% CI 2.13 to 28.55, p=0.002) was identified as an independent risk factor. Inpatient opioid consumption in the top quartile (equivalent to more than 10 mg of oxycodone every 4 hours) was not found to be associated with persistent use.ConclusionLarger amounts of opioid consumed in the hospital following uncomplicated, primary TKA may not be associated with an increased risk of persistent use at 6 weeks among opioid-naïve patients. Patients may have unique risk factors for prolonged opioid use that may not necessarily be apparent in the early postoperative period.

Can the Preoperative Prognostic Nutrition Index (PNI) Predict Surgical Site Infection Following Primary Total Knee Arthroplasty?

2020 ◽  
Author(s):  
JINGSHENG SHI ◽  
JIE YU ◽  
JINGDE DENG ◽  
CHAOJUN ZHENG ◽  
GUANGLEI ZHAO ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Operative Time ◽  
Primary Total Knee Arthroplasty ◽  
Site Infection ◽  
Total Knee ◽  
Male Sex ◽  
Primary Total Knee

Abstract Background:Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, few studies have discussed the effectiveness of PNI as a nutritional assessment in predicting SSI after primary total knee arthroplasty (TKA). The aim of this study is to investigate the relationship between SSI and malnutrition as identified by the PNI scores following TKA. Methods: A retrospective analysis of 483 patients (SSI vs. non-SSI group: 19 vs. 464; follow-up period: at least 1 year) was performed to confirm the risk factors, including the PNI, associated with SSI after primary TKA using both univariate and multivariate analyses. Results: Postoperatively, nineteen patients (19/483, 3.9%) experienced SSI (deep vs. superficial SSI: 12 vs. 7), and periprosthetic joint infection was observed in all deep SSI cases. Univariate analysis showed that male sex, body weight, body mass index (BMI), diabetes mellitus, steroid usage, operative time and PNI differed between the SSI and non-SSI groups (P<0.05). Multivariate logistic regression analysis identified that the preoperative PNI (odds ratio [OR]: 0.859; 95% confidence interval [CI]: 0.762-0.969; cutoff [CV]: 49.27), operative time (OR: 1.005; 95% CI: 1.000-1.010; CV: 131.0 min), male sex (OR: 4.127; 95% CI: 1.165-14.615), diabetes mellitus (OR: 6.133; 95% CI: 2.067-18.193) and steroid usage (OR: 6.034; 95% CI: 1.521-23.935) were independently associated with SSI (P<0.05). Conclusions: A low preoperative PNI associated with malnutrition was demonstrated to be an independent risk factor for SSI following primary TKA. Patients with preoperative low PNI should be cautioned and provided with adequate nutritional intervention to reduce postoperative SSI.

Opioid Use After Total Knee Arthroplasty: Trends and Risk Factors for Prolonged Use

2017 ◽  
Vol 32 (8) ◽  
pp. 2390-2394 ◽  
Author(s):  
Nicholas A. Bedard ◽  
Andrew J. Pugely ◽  
Robert W. Westermann ◽  
Kyle R. Duchman ◽  
Natalie A. Glass ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Opioid Use ◽  
Total Knee

scholarly journals RISK FACTORS FOR EARLY HOSPITAL READMISSION FOLLOWING TOTAL KNEE ARTHROPLASTY

2018 ◽  
Vol 26 (5) ◽  
pp. 309-313 ◽  
Author(s):  
Eva J. Lehtonen ◽  
Matthew C. Hess ◽  
Gerald McGwin Jr. ◽  
Ashish Shah ◽  
Alexandre Leme Godoy-Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Morbid Obesity ◽  
Total Knee Arthroplasty ◽  
Postoperative Complications ◽  
Knee Arthroplasty ◽  
Hospital Readmission ◽  
Operative Time ◽  
Total Knee ◽  
Independent Risk Factors ◽  
Male Sex

ABSTRACT Objective: To identify independent risk factors, complications and early hospital readmission following total knee arthroplasty. Methods: Using the ACS-NSQIP database, we identified patients who underwent primary TKA from 2012-2015. The primary outcome was early hospital readmission. Patient demographics, preoperative comorbidities, laboratory data, operative characteristics, and postoperative complications were compared between readmitted and non-readmitted patients. Logistic regression identified independent risk factors for 30-day readmission. Results: 137,209 patients underwent TKA; 3.4% were readmitted within 30 days. Advanced age, male sex, black ethnicity, morbid obesity, presence of preoperative comorbidities, high ASA classification, and increased operative time were independently related risk factors. Asian and no reported race were negative risk factors. Postoperative complications: acute myocardial infarction, acute renal failure, stroke, pneumonia, pulmonary embolism, and deep vein thrombosis show positive associations. Conclusions: Advanced age, male sex, black ethnicity, morbid obesity, presence of comorbidities, high ASA classification and long operative time are independent risk factors for postoperative complications and early hospital readmission following total knee arthroplasty. Level of Evidence III, Case control study.

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