Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty

Reuben, Jeffrey D.; Meyers, Steven J.; Cox, Dennis D.; Elliott, Marc Bruce; Watson, M.; Shim, Sharon D.

doi:10.1016/s0883-5403(98)90095-x

Cited by 267 publications

(173 citation statements)

References 6 publications

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“…Many patients present with symptomatic bilateral knee osteoarthritis, and many of these patients opt to have bilateral TKAs [23]. In 2007, approximately 7% of all TKAs performed in the United States were same-day bilateral [12] and 15% were staged bilateral (two sequential unilateral TKAs performed within 1 year) [1].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Poultsides

Memtsoudis

Valle

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified. Questions/purposes We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than 3 months apart (staged 3-12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities. Methods We analyzed institutional data from 3960 sameday, 172 staged 0-3, and 1533 staged 3-12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Sameday patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality. Results There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group. Conclusions In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that sameday bilateral TKAs appeared to be safe.

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Section: Introductionmentioning

confidence: 99%

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Poultsides

Memtsoudis

Valle

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…Opponents of the simultaneous approach cite increased perioperative complications, including pulmonary embolism, major cardiac events, ileus, higher transfusion rates, confusion, and death [1,4,12,15,21,23,27,33,35]. Concern also exists regarding the financial disincentive to the surgeon for performing bilateral simultaneous arthroplasty procedures [2,6,28]. However, without a double-blinded, randomized controlled trial comparing bilateral simultaneous with staged TKA, the debate will continue and the surgeon must weigh the risks and benefits with the patient's expectations and goals when bilateral surgery is indicated.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Complications of Simultaneous versus Staged Unicompartmental Knee Arthroplasty

Berend¹,

Morris²,

Skeels³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…The advantages reported with simultaneous bilateral TKAs are both knees can be treated during one hospital stay, and after one rehabilitation period, the patients can experience the benefits of TKA for both knees with less cost for the individual and society [5,18]. The safety of simultaneous bilateral TKAs has been a concern, and in a recent meta-analysis, a higher risk of serious cardiac complications, pulmonary complications, and mortality was reported with simultaneous bilateral TKAs compared with staged bilateral or unilateral TKAs [17].…”

Section: Introductionmentioning

confidence: 99%

Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register

Stefánsdóttir¹,

Lidgren²,

Robertsson³

2008

Clinical Orthopaedics &Amp; Related Research

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Patients with knee osteoarthritis (OA) often present with symptoms that warrant bilateral TKAs. There are potential benefits to operating on both knees on the same day, but the safety of simultaneous bilateral TKAs has been questioned. To evaluate whether there were any differences in 30-day mortality between patients having simultaneous bilateral TKAs and those having staged bilateral TKAs, we analyzed data from the Swedish Knee Arthroplasty Register and the Swedish Cause of Death Register. We included 48,931 patients with OA having 60,062 primary TKAs during 1985 to 2004; 1139 had surgery on both knees on the same day (simultaneous bilateral) and 3432 had surgery on both knees on two different occasions with less than 1 year between operations (staged bilateral). The 30-day mortality after simultaneous bilateral TKAs was 7.53 (confidence interval, 2.62-21.69) times higher than after the second of staged TKA and 3.77 (confidence interval, 2.04-6.98) times higher than after a primary unilateral TKA. Assuming the total risk for a staged procedure is twice that of a unilateral procedure, the risk of mortality within 30 days is 1.94 (confidence interval, 1.05-3.59) times higher with simultaneous than staged TKA. It is safer to operate on one knee at a time.

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Cost comparison between bilateral simultaneous, staged, and unilateral total joint arthroplasty

Cited by 267 publications

References 6 publications

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Perioperative Complications of Simultaneous versus Staged Unicompartmental Knee Arthroplasty

Higher Early Mortality with Simultaneous Rather than Staged Bilateral TKAs: Results From the Swedish Knee Arthroplasty Register

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