Duration of Anesthesia and Venous Thromboembolism After Hip and Knee Arthroplasty

Jaffer, Amir K.; Barsoum, Wael K.; Krebs, Viktor E.; Hurbanek, Jason G.; Morra, Nariman; Brotman, Daniel J.

doi:10.1016/s0025-6196(11)61526-7

Cited by 104 publications

(46 citation statements)

References 22 publications

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“…Although patients undergoing revision surgery may have a greater risk of complications and mortality [9,14,19,24,26], the risk of subsequent revision and the relative importance of various risk factors are unclear. Therefore, we sought to characterize the relative risk of subsequent revision after primary and revision TJAs and evaluate predisposing patient risk factors for revision in the elderly US Medicare patient population.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Ong

Lau

Suggs

et al. 2010

Clinical Orthopaedics &Amp; Related Research

250

155

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Background Revision is technically more demanding than primary total joint arthroplasty (TJA) and requires more extensive use of resources. Understanding the relative risk of rerevision and risk factors can help identify patients at high risk who may require closer postsurgical care. Objectives/purposes We therefore evaluated the risk of subsequent revision after primary and revision TJA in the elderly (65 years or older) patient population and identified corresponding patient risk factors. Patients and Methods Using the 5% Medicare claims data set (1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006), we identified a total of 35,746 patients undergoing primary THA and 72,913 undergoing primary TKA; of these, 1205 who had THAs and 1599 who had TKAs underwent initial revision surgery. The rerevision rate after primary and revision TJAs was analyzed by the Kaplan-Meier method. The relative risk of revision surgery for primary and revision TJAs was compared using hazard ratio analysis. ResultsThe 5-year survival probabilities were 95.9%, 97.2%, 81.0%, and 87.4% for primary THA and TKA and revision THA and TKA, respectively. Patients with revision arthroplasty were five to six times more likely to undergo rerevision (adjusted relative risk, 4.89 for THA; 5.71 for TKA) compared with patients with primary arthroplasty. Age and comorbidities were associated with initial revision after primary THA and TKA. Conclusions Patients should undergo stringent preoperative screening for preexisting health conditions and careful patient management and followup postoperatively so as to minimize the risk of an initial revision, which otherwise could lead to a significantly greater likelihood of subsequent rerevisions.

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Section: Discussionmentioning

confidence: 99%

“…Revision TJAs are associated with elevated risks of complications such as dislocations, infections, venous thromboembolism [9,14,19,24,26], and mortality [19,26]. Improvement in quality of life after revision surgery also may be more limited in comparison to primary TJA [18,23].…”

Section: Introductionmentioning

confidence: 99%

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Ong

Lau

Suggs

et al. 2010

Clinical Orthopaedics &Amp; Related Research

250

155

View full text Add to dashboard Cite

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“…Additionally general anesthesia affects diaphragmatic function due to the relaxing of muscular fibers and also decrease mucociliary clearance predisposing POC mostly if it is prolonged 26 . In the present study, the time of anesthesia was higher in the subgroups that presented complications and can have contributed for the occurrence of POC.…”

Section: Intraoperative Variablesmentioning

confidence: 99%

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery

Arruda

Catâneo

2013

Acta Cir. Bras.

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“…This increased complexity has led to a concomitant rise in the duration of anaesthesia. Studies from other surgical specialities suggest an association between longer anaesthesia, which we have defined as the time from induction of anaesthesia until transfer of care in the post-anaesthesia care unit, and higher rates of surgical complications, such as myocardial infarction and pulmonary embolism [1][2][3][4]. Unfortunately, this concept has, to our knowledge, not yet been explored for urological surgery.…”

Section: Introductionmentioning

confidence: 99%

How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

et al. 2008

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OBJECTIVETo examine the association between the duration of anaesthesia and non‐urological complication (NUC) rates after surgery, as the increasing complexity of minimally invasive and laparoscopic procedures in urology has resulted in longer surgery and anaesthesia, and information on the effect of this on NUC rates is limited.PATIENTS AND METHODSWe identified 2196 patients who had open radical nephrectomy or nephron‐sparing surgery at our institution between 1989 and 2002. Patients were subdivided into groups I, II, and III according to the duration of general anaesthesia (<4, 4–6 and ≥6 h, respectively). NUCs after surgery, and mortality during and after surgery, were evaluated.RESULTSThere were 1340, 723, and 133 patients in groups I, II and III, respectively. The incidences of any NUC were 3.1%, 5.8% and 13.5%, respectively. The odds ratios for the likelihood of a NUC were 1.91 (P = 0.004) and 4.84 (P < 0.001) for groups II and III, respectively. These differences remained significant even after adjusting for patient and tumour characteristics. Perioperative mortality was highest in group III, at 2.3%, vs 0.4% in groups I and II.CONCLUSIONSLonger anaesthesia is associated with an increase in the incidence of perioperative complications and mortality, especially when the duration of anaesthesia is >6 h. This increase appears to be independent of patient’s preoperative health status, tumour extent and blood loss.

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Duration of Anesthesia and Venous Thromboembolism After Hip and Knee Arthroplasty

Cited by 104 publications

References 22 publications

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

Surgical risk tests related to cardiopulmonary postoperative complications: comparison between upper abdominal and thoracic surgery

How long is too long? The effect of the duration of anaesthesia on the incidence of non‐urological complications after surgery

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