scholarly journals Is Prevention of Postoperative Vomiting Surgery Dependent? A Retrospective Cohort Study of Total Knee Arthroplasty

2021 ◽  
Vol 11 (10) ◽  
pp. 1018
Author(s):  
Yan-Yuen Poon ◽  
Kuo-Chuan Hung ◽  
Wen-Yi Chou ◽  
Chih-Hsien Wang ◽  
Chao-Ting Hung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Study Endpoint ◽  
Clinical Settings ◽  
Postoperative Vomiting ◽  
Female Sex ◽  
Total Knee ◽  
Independent Risk Factors

The study of postoperative nausea and vomiting (PONV) has been ongoing since the early days of general anesthesia. The search for risk factors of PONV and the development of new agents to treat PONV are the two main strategies to combat the adverse side effects of general anesthesia. Female sex, non-smoking status, a history of PONV/motion sickness, and postoperative opioid use are the four independent risk factors for PONV derived after a series of prospective studies, evidence-based systematic reviews, and meta-analyses. The two frequently asked questions that arise ask whether risk factors apply to different clinical settings and whether prevention measures of PONV can be surgery dependent. We conducted a comprehensive review of 665 patients who underwent primary total knee arthroplasty (TKA) between January and December 2019. As nausea is subjective and its measurement is not standardized, postoperative vomiting (POV) was used as a study endpoint. The exclusion criteria were desflurane anesthesia, spinal anesthesia, anesthesia without bispectral index monitoring, and day surgery. Three well-recognized risk factors, consisting of body weight, sevoflurane consumption, and postoperative opioid consumption, were not considered as independent risk factors of POV, while female sex, preoperative adductor canal block (ACB), and dexamethasone were identified as being so in this study. The risk of POV in the female sex was 2.49 times that in the male sex; however, when dexamethasone was used, this risk was reduced by >40% compared with no antiemetic use, and by >50% when patients received preoperative ACB compared with those without the block. The clinical characteristics of our TKA patients—female dominance, old age, and their fairly constant body weights that were distinct from those of other surgical patients—suggested that age may play a crucial role in determining the relative contributions of the different risk factors of POV. We concluded that risk factors of POV are dependent on clinical settings. Based on these results, it is reasonable to speculate that a surgery-dependent plan for the prevention of POV is feasible for patients in similar clinical settings.

Inpatient Falls after Total Knee Arthroplasty

2014 ◽  
Vol 120 (3) ◽  
pp. 551-563 ◽  
Author(s):  
Stavros G. Memtsoudis ◽  
Thomas Danninger ◽  
Rehana Rasul ◽  
Jashvant Poeran ◽  
Philipp Gerner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Orthopedic Procedures ◽  
Inpatient Falls ◽  
Total Knee ◽  
Anesthesia Technique

Abstract Background: Much controversy remains on the role of anesthesia technique and peripheral nerve blocks (PNBs) in inpatient falls (IFs) after orthopedic procedures. The aim of the study is to characterize cases of IFs, identify risk factors, and study the role of PNB and anesthesia technique in IF risk in total knee arthroplasty patients. Methods: The authors selected total knee arthroplasty patients from the national Premier Perspective database (Premier Inc., Charlotte, NC; 2006–2010; n = 191,570, >400 acute care hospitals). The primary outcome was IF. Patient- and healthcare system–related characteristics, anesthesia technique, and presence of PNB were determined for IF and non-IF patients. Independent risk factors for IFs were determined by using conventional and multilevel logistic regression. Results: Overall, IF incidence was 1.6% (n = 3,042). Distribution of anesthesia technique was 10.9% neuraxial, 12.9% combined neuraxial/general, and 76.2% general anesthesia. PNB was used in 12.1%. Patients suffering IFs were older (average age, 68.9 vs. 66.3 yr), had higher comorbidity burden (average Deyo index, 0.77 vs. 0.66), and had more major complications, including 30-day mortality (0.8 vs. 0.1%; all P < 0.001). Use of neuraxial anesthesia (IF incidence, 1.3%; n = 280) had lower adjusted odds of IF compared with adjusted odds of IF with the use of general anesthesia alone (IF incidence, 1.6%; n = 2,393): odds ratio, 0.70 (95% CI, 0.56–0.87). PNB was not significantly associated with IF (odds ratio, 0.85 [CI, 0.71–1.03]). Conclusions: This study identifies several risk factors for IF in total knee arthroplasty patients. Contrary to common concerns, no association was found between PNB and IF. Further studies should determine the role of anesthesia practices in the context of fall-prevention programs.

scholarly journals Risk factors for a post-operative neutrally aligned total knee arthroplasty in the sagittal plane developing fixed flexion deformity at 2 years follow up study

2019 ◽  
Vol 5 (2) ◽  
pp. 211 ◽  
Author(s):  
Amila Silva ◽  
Sharon Tan ◽  
Adriel Tay ◽  
Hee Nee Pang ◽  
Ngai Nung Lo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Sagittal Plane ◽  
P Value ◽  
Flexion Deformity ◽  
Maximum Flexion ◽  
Total Knee ◽  
Independent Risk Factors ◽  
Fixed Flexion Deformity

<p class="abstract"><strong>Background:</strong> The incidence of fixed flexion deformity (FFD) following total knee arthroplasty (TKA) has been reported to be as high as 17%, increasing demand on the quadriceps and hindering mobility. The aim of this study is then to identify these predictors for the development of FFD.</p><p class="abstract"><strong>Methods:</strong> In this retrospective study, all patients who underwent primary TKA from January 2008 to June 2009 at a single institution were identified. All patients with neutral alignment in the sagittal place of the knee intra-operatively were identified and followed up. The knee motion was measured in both operated and contralateral knees and followed-up for a minimum of 24 months post-operatively.<strong></strong></p><p class="abstract"><strong>Results:</strong> Multivariate analysis demonstrated pre-operative FFD of the non-operated knee (p-value 0.03), pre-operative range of motion of the operated knee (p-value 0.01) and non-operated (p-value 0.01) knee and pre-operative maximum flexion of the operated knee (p-value 0.001) to be independent risk factors for development of FFD at 24 months.</p><p class="abstract"><strong>Conclusions:</strong> Independent risk factors for the development of post-operative FFD in TKA are pre-operative FFD of the operated knee, FFD of the non-operated knee and the maximum flexion of the operated knee. The relative risk of a male developing FFD is also as high as 1.34.</p>

Differences in the Risk Factors for Surgical Site Infection between Total Hip Arthroplasty and Total Knee Arthroplasty in the Korean Nosocomial Infections Surveillance System (KONIS)

2012 ◽  
Vol 33 (11) ◽  
pp. 1086-1093 ◽  
Author(s):  
Kyoung-Ho Song ◽  
Eu Suk Kim ◽  
Young Keun Kim ◽  
Hye Young Jin ◽  
Sun Young Jeong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Total Hip Arthroplasty ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Nosocomial Infections ◽  
Surveillance System ◽  
Total Knee ◽  
Independent Risk Factors ◽  
Incisional Ssis

Objective.To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems.Design.Retrospective cohort study.Setting.Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS).Patients.From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled.Results.SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were “severe” SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA.Conclusions.Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.

scholarly journals Risk Factors of Early Periprosthetic Femoral Fracture After Total Knee Arthroplasty

2021 ◽  
Author(s):  
Chaturong Pornrattanamaneewong ◽  
Akraporn Sitthitheerarut ◽  
Pakpoom Ruangsomboon ◽  
Keerati Chareancholvanich ◽  
Rapeepat Narkbunnam
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Femoral Fracture ◽  
Control Group ◽  
Periprosthetic Femoral Fracture ◽  
Radiographic Outcomes ◽  
Total Knee ◽  
Independent Risk Factors ◽  
Preoperative Deformity

Abstract BackgroundPeriprosthetic femoral fracture (PFF) is a serious complication after total knee arthroplasty (TKA). However, the risk factors of PFF in the early postoperative setting are not well documented. This study determines the risk factors of early PFF after primary TKA.MethodsThis study recruited 24 patients who had early PFF within postoperative 3 months and 96 control patients. Demographic data (age, gender, weight, height, body mass index, Deyo-Charlson comorbidity index, diagnosis, operated side, underlying diseases and history of steroid usage intraoperative outcomes), intraoperative outcomes (operative time, surgical approach, type and brand of the prosthesis), and radiographic outcomes (distal femoral width; DFW, prosthesis-distal femoral width ratio; PDFW ratio, anatomical lateral distal femoral angle; LDFA, femoral component flexion angle; FCFA and anterior femoral notching; AFN) were recorded and compared between groups. Details of PFF, including fracture pattern, preoperative deformity, and time to PFF were also documented.ResultsIn univariate analysis, the PFF group had significantly older, right side injury, rheumatoid, dyslipidemia, Parkinson patients than the control group (p < 0.05). No cruciate-retaining design was used in PFF group (p = 0.004). Differences between the prosthetic brand used were found in this study (p = 0.046). For radiographic outcomes, PFF group had significantly lower DFW but higher PDFW ratio and LDFA than the control group (p < 0.05). While FCFA and AFN were similar between groups. The fracture patterns were medial condylar (45.8%), lateral condylar (25.0%) and supracondylar fracture (29.2%). The mean overall time to PFF was 37.2 ± 20.6 days (range 8 – 87 days). Preoperative deformity was significantly different among the three patterns (p < 0.05). When analyzed using the logistic regression model, age and dyslipidemia were only two independent risk factors for early PFF. The cut-off point of age was > = 75 years, with a sensitivity of 75.0% and specificity of 78.1%. The odds ratio of dyslipidemia was 6.63 (95% confidence interval, 1.11 to 39.8).ConclusionThis study determined that age and dyslipidemia were the independent risk factors for early PFF. However, further well-controlled studies with a larger sample size were needed to address this issue.

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.

scholarly journals The Analysis of Risk Factors in No Thumb Test in Total Knee Arthroplasty

2011 ◽  
Vol 3 (4) ◽  
pp. 274 ◽  
Author(s):  
Jee Hyoung Kim ◽  
Song Lee ◽  
Dong Oh Ko ◽  
Chang Wook Yoo ◽  
Tae Hwan Chun ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Total Knee

scholarly journals Wound Issues after Total Knee Arthroplasty

2015 ◽  
Vol 5 (1) ◽  
pp. 10-13
Author(s):  
Douglas A Dennis
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Soft Tissues ◽  
Wound Complications ◽  
Operative Techniques ◽  
Proper Selection ◽  
Wound Healing Problems ◽  
Total Knee ◽  
Selection Of

ABSTRACT Wound healing problems following total knee arthroplasty (TKA) are infrequent, but if present may lead to devastating results. Occurrence may be minimized by modifying patient risk factors, proper selection of skin incisions, and using operative techniques that protect soft tissues. When wound complications arise, prompt management is imperative to assure the best outcome after TKA. Jennings JM, Dennis DA. Wound Issues after Total Knee Arthroplasty. The Duke Orthop J 2015;5(1):10-13.

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