Emergency Department Presentation After Total Hip and Knee Arthroplasty: A Systematic Review

Maldonado-Rodriguez, Naomi; Ekhtiari, Seper; Khan, Moin; Ravi, Bheeshma; Gandhi, Rajiv; Veillette, Christian; Leroux, Timothy

doi:10.1016/j.arth.2020.05.022

Cited by 21 publications

(12 citation statements)

References 48 publications

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“…While the definitive causes of these differences remain to be elucidated, we speculate that the reasons may be multifactorial. Firstly, the recall window for adverse events was slightly longer (42 days) than previous reports (30 days) 29 . Secondly, a number of the readmissions were from adverse events largely unrelated to surgery (e.g., trauma from accidents) and the increase observed may be natural variation over time.…”

Section: Discussionmentioning

confidence: 77%

Patient‐reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018–2019

Fatima¹,

Scholes²,

Tutty

et al. 2022

ANZ Journal of Surgery

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Background Patient‐reported outcomes and satisfaction following short length of stay (LoS) after total knee arthroplasty (TKA) in the Australian regional context remain unexplored. This study reports complications, outcomes and satisfaction of patients discharged from an enhanced recovery protocol (ERP), 6 weeks after TKA in a regional hospital. Methods Prospective recruitment occurred between 2018 and 2019. Demographics, intraoperative data, complications and emergency department (ED) presentations were retrieved from hospital records. Complications were graded for severity using a published scale. Knee range of motion (ROM), timed up‐and‐go (TUG), 6‐min walk test (6MWT) and Oxford Knee Scores (OKS) were assessed preoperatively and 6 weeks postoperatively. Patient satisfaction was assessed via questionnaire at the postoperative follow‐up. Results One hundred patients/117 primary TKAs were prospectively included. Median LoS was 2 days (interquartile range 1–3 days) with 74.4% and 88.4% of patients satisfied with their knee and LoS, at 6 weeks respectively. Twenty‐seven patients presented to the ED a total of 37 times with complication severity of Grade III or less, and 10 patients were readmitted. Significant improvements in objective and subjective outcomes were observed, however only change in median OKS exceeded the minimal clinically important difference (MCID) threshold. Conclusion An enhanced recovery protocol after TKA in a regional hospital can achieve a median LoS of 2 days without compromising patient‐reported outcomes and objective functional measures, whilst maintaining a high level of patient satisfaction with both the surgery and LoS. Further work is required to better optimize management of largely low‐grade complications in this patient population.

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Section: Discussionmentioning

confidence: 77%

Patient‐reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018–2019

Fatima¹,

Scholes²,

Tutty

et al. 2022

ANZ Journal of Surgery

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“… 28 ED presentation and readmission after total knee and total hip arthroplasty have proven to be a high burden to the health care system and have prompted discussion about patient-centered interventions that can safely intervene and prevent those outcomes. 35 Our results suggest that patients with sustained opioid use after surgery require both monitoring and judicious intervention 26 to optimize their safety and lower the risk for ED visits and hospital admissions after index arthroscopy.…”

Section: Discussionmentioning

confidence: 78%

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

Rogers

LaBelle

Kim

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background: Opioids are commonly used to treat postoperative pain; however, guidelines vary regarding safe opioid use after hip arthroscopy. Purpose/Hypothesis: The purposes were to (1) identify risk factors for persistent opioid use, (2) assess the effect of opioid use on outcomes, and (3) describe common opioid prescribing patterns after hip arthroscopy. It was hypothesized that preoperative opioid use would affect complication rates and result in greater postoperative opioid use. Study Design: Case-control study; Level of evidence 3. Methods: The Utah State All Payer Claims Database was queried for patients who underwent hip arthroscopy between January 2013 and December 2017. Included were patients ≥14 years of age at index surgery with continuous insurance. Patients were separated into acute (<3 months) and chronic (≥3 months) postoperative opioid use groups. Primary outcomes included revision surgery, complications (infection, pulmonary embolism/deep venous thrombosis, death), emergency department (ED) visits, and hospital admissions. Multivariate logistic regression was utilized to identify factors associated with the outcomes. Results: Included were 2835 patients (mean age, 47 years; range, 14-64 years), of whom 2544 were in the acute opioid use and 291 were in the chronic opioid use group. Notably, 91% of the patients in the chronic group took opioid medications preoperatively, and they were more than twice as likely to carry a mental health diagnosis ( P < .01). Patients in the acute group had a significantly shorter initial prescription duration, took fewer opioid pills, and had fewer refills than those in the chronic group ( P < .01 for all). Patients in the chronic group had a significantly higher risk of postoperative ED visits (odds ratio [OR], 2.76; P = .008), hospital admission (OR, 3.02; P = .002), and additional surgery ( P = .003), as well as infection (OR, 2.55; P < .001) and hematoma (OR, 2.43; P = .030). Patients who had used opioids before hip arthroscopy were more likely to need more refills ( P < .01). A formal opioid use disorder diagnosis correlated significantly with postoperative hospital admissions (OR, 3.83; P = .044) and revision hip arthroscopy (OR, 4.72; P = .003). Conclusion: Mental health and substance use disorders were more common in patients with chronic postoperative opioid use, and chronic postoperative opioid use was associated with greater likelihood of postoperative complications. Preoperative opioid use was significantly correlated with chronic postoperative opioid use and with increased refill requests after index arthroscopy.

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“…Only 1.9% of patients presented to the ED within 30 days of surgery. Maldonado-Rodriguez et al (2020) summarized available literature (27 studies; 1,484,043 patients) on ED visits after total hip and knee replacements, finding on average a 6.5% rate of 30-day ED visits [36]. Finnegan et al (2017) reported that ED visits occur more frequently than readmissions and often just for pain [2,3,18,20,26,29-34, 37e39].…”

Section: Discussionmentioning

confidence: 99%

The ABLE Anterior-Based Muscle-Sparing Approach: A Safe and Effective Option for Total Hip Arthroplasty

Rana¹,

Sturgeon²,

McGrory³

et al. 2022

Arthroplasty Today

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Emergency Department Presentation After Total Hip and Knee Arthroplasty: A Systematic Review

Cited by 21 publications

References 48 publications

Patient‐reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018–2019

Patient‐reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018–2019

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

The ABLE Anterior-Based Muscle-Sparing Approach: A Safe and Effective Option for Total Hip Arthroplasty

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