45-day mortality after 467 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study

Hunt, Linda; Ben-Shlomo, Yoav; Clark, Emma; Dieppe, Paul; Judge, Andrew; Macgregor, Alexander; Tobias, Jonathan H; Vernon, Kelly; Blom, Ashley W

doi:10.1016/s0140-6736(14)60540-7

Cited by 171 publications

(167 citation statements)

References 26 publications

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“…In 18434 patients undergoing orthopedic surgery, ASA class was associated with postoperative outcome, functional status and frequency of revision operations. The mean age, gender distribution, ASA classes and comorbidities in the present study are comparable to different studies on TKA [16,17]. During both periods of time surgical techniques, regional anesthesia, postoperative care, and attending surgeons and anesthetists were unchanged.…”

Section: Discussionsupporting

confidence: 83%

Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

Kozian¹

2017

SDRP-JAS

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Background:Combined epidural analgesia (EA) and patient controlled analgesia (PCA) for postoperative pain control after total knee arthroplasty (TKA) is well established. Previous studies demonstrated the effectiveness of femoral nerve block (FNB) in combination with PCA. This study compares clinical efficiency and adverse events of pain therapy of an established (EA+PCA) and a modified (FNB+PCA) protocol. Methods:A retrospective, single-center cohort study analyzing TKA patients after subarachnoid anesthesia. Matched pair analysis was performed using filters for American Society of Anesthesiologists (ASA) classification, age, gender, height, weight, comorbidities and prior use of analgesics. Surgical technique and postoperative medication protocol were similar in both groups. Primary outcome was postoperative pain on movement assessed by a visual analog scale (VAS) and use of analgesics within 72 hours after surgery. Secondary, incidence of adverse events (postoperative nausea and vomiting, pruritus, urinary retention and hypotension) was examined.Results: From a total of 846 patients, 104 matched pairs were built and analyzed within 72 hours after surgery. Mean VAS scores were similar in patients receiving EA+PCA (2.7 ± 1.1) or FNB+PCA (2.8 ± 1.2). Supplemental opioid administration was higher in EA+PCA patients. Hypotension was more frequent in EA+PCA as in FNB+PCA patients (36 % vs. 12 %). Combined adverse events were more frequent in EA+PCA as in FNB+PCA patients (75 % vs. 58 %). Conclusion: Both FNB+PCA and EA+PCA results in equivalent degrees of analgesia after TKA. Converting an established mode of pain therapy to a modified protocol may decrease incidence of adverse events rather than improve quality of analgesia. EPIDURAL ANALGESIA COMPARED WITH FEMORAL NERVE BLOCK FOR POSTOPERATIVE PAIN THERAPY AFTER TOTAL KNEE ARTHROPLASTY -A MATCHED PAIR ANALYSIS

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Section: Discussionsupporting

confidence: 83%

Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

Kozian¹

2017

SDRP-JAS

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“…Comorbidities are known to affect outcomes following joint replacement surgery 43. Although there is limited research on the effects of comorbidities on nonsurgical OA treatments, they likely also affect these outcomes and, in some cases, the available treatment options.…”

Section: Resultsmentioning

confidence: 99%

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

Rolfson

Wissig²,

Maasakkers³

et al. 2016

Arthritis Care & Research

125

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ObjectiveTo define a minimum Standard Set of outcome measures and case‐mix factors for monitoring, comparing, and improving health care for patients with clinically diagnosed hip or knee osteoarthritis (OA), with a focus on defining the outcomes that matter most to patients.MethodsAn international working group of patients, arthroplasty register experts, orthopedic surgeons, primary care physicians, rheumatologists, and physiotherapists representing 10 countries was assembled to review existing literature and practices for assessing outcomes of pharmacologic and nonpharmacologic OA therapies, including surgery. A series of 8 teleconferences, incorporating a modified Delphi process, were held to reach consensus.ResultsThe working group reached consensus on a concise set of outcome measures to evaluate patients’ joint pain, physical functioning, health‐related quality of life, work status, mortality, reoperations, readmissions, and overall satisfaction with treatment result. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were defined. Annual outcome measurement is recommended for all patients.ConclusionWe have defined a Standard Set of outcome measures for monitoring the care of people with clinically diagnosed hip or knee OA that is appropriate for use across all treatment and care settings. We believe this Standard Set provides meaningful, comparable, and easy to interpret measures ready to implement in clinics and/or registries globally. We view this set as an initial step that, when combined with cost data, will facilitate value‐based health care improvements in the treatment of hip and knee OA.

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“…[1][2][3][4][5][6][7][8] Risk factors for post-TKR mortality include age at operation, male sex, too high or low body mass index, American Society of Anesthesiologists (ASA) class 3 to 4, presence of co-morbidities, and simultaneous bilateral surgery. [1][2][3][4][6][7][8][9][10][11][12] There are a lack of similar data for the Asian population, however, and the risk of mortality in a high-volume hospital has not been described locally. The aims of the study were to review the mortality of primary TKR in Hong Kong and to identify risk factors of post-TKR mortality in a highvolume hospital.…”

Section: Implications For Clinical Practice or Policymentioning

confidence: 99%

Mortality following primary total knee replacement in public hospitals in Hong Kong

Lee¹,

Mak²,

Wong³

2016

Hong Kong Med J

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45-day mortality after 467 779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study

Cited by 171 publications

References 26 publications

Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

Epidural analgesia compared with femoral nerve block for postoperative pain therapy after total knee arthroplasty – a matched pair analysis

Defining an International Standard Set of Outcome Measures for Patients With Hip or Knee Osteoarthritis: Consensus of the International Consortium for Health Outcomes Measurement Hip and Knee Osteoarthritis Working Group

Mortality following primary total knee replacement in public hospitals in Hong Kong

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