Analysis of Preoperative Screening Criteria for Total Joint Arthroplasty in a Veteran Population

Stiegel, Kelly R.; Lash, Jonathan G.; Sun, Daniel; Green, David M.; Harrington, Melvyn A.; Cahill, Catherine W.

doi:10.1016/j.arth.2019.12.023

Cited by 1 publication

(1 citation statement)

References 27 publications

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“…Evidence-based preoperative optimization as a risk reduction tool has been recommended by several authors, who have acknowledged its benefits in reducing the incidence of complications, length of stay, and 90-day readmission rates, akin to our study. 5 7 30 32 33) In contrast to our findings, Bernstein et al, 7) Ryan et al, 28) and Dlott et al 33) in their studies using an RM strategy did not appreciate significant difference in 90-day readmission rates and emergency room visits although they too found reduction in length of stay and discharge to the skilled nursing facility. This may be attributed to the lack of uniform protocols, as the study was conducted at 3 different centers and they themselves pointed out that although there was some attempt at RM by deferring the surgery by few weeks, unlike our study, they could not establish whether endpoints of optimization of comorbidities or RM were achieved before surgery.…”

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confidence: 96%

Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

et al. 2022

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Background With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. Methods This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. Results TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group ( p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). Conclusions Screening and RM can reduce 90-day complications in patients undergoing TKA.

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