Impact of Charlson indices and comorbid conditions on complication risk in bilateral simultaneous total knee arthroplasty

Marya, S. K. S.; Amit, Priyadarshi; Singh, Chandeep

doi:10.1016/j.knee.2016.05.013

Cited by 33 publications

(24 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The 80 years and over age group and the presence of comorbidities were the main variables that were independently associated with higher mortality, which is consistent with reports by other studies. [24][25][26][27][28] In addition, sociodemographic factors, such as age group and region, related to the patients were also associated with mortality. The patient's insurer was found to be an independent predictor of mortality.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is one of the most frequent orthopaedic surgeries. The purpose of this study was to determine the 30-day postoperative mortality rate, total episode-of-care costs, and prognostic factors associated with these outcomes, for adult patients who underwent TKA in Colombia's contributory health care system. A retrospective cohort study of all adult patients enrolled in Colombia's contributory health system, who underwent TKA between January 1, 2012 and November 30, 2015 was performed. Thirty-day postoperative mortality rates, 30-day ICU admissions rates, 30-day hospital readmission rates, 1-year arthroplasty revision rates, and total episode-of-care costs were estimated. Multilevel, generalized linear models were generated, to determine the prognostic factors associated with outcomes presented. A total of 12,453 patients were included. The 30-day mortality rate was 0.13 per 100 surgeries and the ICU admissions rate at 30 days postoperative was 4.44 per 100 surgeries. The 30-day hospital readmission rate was 4.28 per 100 surgeries and the 1-year arthroplasty revision rate was 1.22 per 100 surgeries. The prognostic factors associated with mortality were age, Charlson Index, and type of insurer. The prognostic factors associated with hospital readmission were age category, Charlson Index, and geographic region; younger age and higher Charlson Index were found to be associated with a higher 1-year arthroplasty revision rate. The median of total episode-of-care costs was USD$ 6,190.07 (interquartile range: 2,299–7,282). The multivariate model found that age, the Charlson Index, the Atlantic region, and type of insurer were associated with the costs incurred by the health system. For patients undergoing TKA in Colombia, age, the Charlson Index, insurers, and geographic region are associated with mortality, ICU admissions, 30-day hospital readmissions, 1-year arthroplasty revisions, and total costs incurred by the health system.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

2020

View full text Add to dashboard Cite

show abstract

“…Pre-operative cardiology optimisation is essential to reduce post-operative cardiac events. However, no validated, orthopaedic-specific cardiac risk stratification tools are available to guide orthopaedic referral of patients to cardiology [ 3 , 19 – 21 ]. There has been no previous research on cardiac referral for the asymptomatic preoperative TJA population in which cardiac disease not yet exhibiting clinical manifestation but capable of contributing to risk of postoperative cardiac complication may exist.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the ‘asymptomatic’ patient

et al. 2020

View full text Add to dashboard Cite

Background No validated pre-operative cardiac risk stratification tool exists that is specific for total hip and total knee arthroplasty (THA and TKA, respectively). To reduce the risk of post-operative cardiac complication, surgeons need clear guidance on which patients are likely to benefit from pre-operative cardiac optimisation. This is particularly important for asymptomatic patients, where the need is harder to determine. Methods Primary THA and TKA performed between January 1, 2010, and December 31, 2017, were identified from a single orthopaedic practice. Over 25 risk factors were evaluated as predictors for patients requiring additional cardiac investigation beyond an ECG and echocardiogram, and for cardiac abnormality detected upon additional investigation. A multivariate logistic regression was conducted using significant predictor variables identified from inferential statistics. A series of predictive scores were constructed and weighted to identify the influence of each variable on the ability to predict the detection of cardiac abnormality pre-operatively. Results Three hundred seventy-four patients were eligible for inclusion. Increasing age (p < 0.001), history of cerebrovascular accident (p = 0.018), family history of cardiovascular disease (FHx of CVD) (p < 0.001) and decreased ejection fraction (EF) (p < 0.001) were significant predictors of additional cardiac investigation being required. Increasing age (p = 0.003), male gender (p = 0.042), FHx of CVD (p = 0.001) and a reduced EF (p < 0.001) were significantly predictive for the detection of cardiac abnormality upon additional cardiac investigation. Conclusions Increasing age, male gender, FHx of CVD and decreased ejection fraction are important risk factors to consider for pre-operative cardiac optimisation in THA and TKA patients. These findings can be applied towards future predictive models, to determine which asymptomatic patients are likely to benefit from pre-operative cardiac referral.

show abstract

“…Among the 18 studies included in this analysis, 12 studies [14,[22][23][24][25][26][27][28][29][30][31][32] were based on administrative data and 6 studies [15,21,[33][34][35][36] on hospital data. Among the 18 studies, 4 studies [23,27,29,31] reported the outcome of THA, 7 studies [22,24,28,[32][33][34][35] reported the outcome of TKA, and the remaining 7 studies [14,15,21,25,26,30,36] reported the outcomes of both THA and TKA.…”

Section: Study Characteristicsmentioning

confidence: 99%

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

Kim

Lee

et al. 2020

Knee Surg & Relat Res

View full text Add to dashboard Cite

Background: This meta-analysis was conducted to evaluate the differences in preoperative comorbidities, postoperative mortality, the rate of periprosthetic joint infection (PJI), and revision rate after total joint arthroplasty (TJA) between patients with chronic kidney disease (CKD)(CKD group) and patients with normal kidney function (non-CKD group). Methods: We searched MEDLINE, EMBASE, and the Cochrane Library for studies assessing the effect of CKD on TJA outcome. This meta-analysis included studies that (1) compared the outcomes of TJA between the CKD and non-CKD groups; (2) compared the outcomes of TJA based on CKD stage; and (3) evaluated the risk factors for morbidity or mortality after TJA. We compared the mortality, PJI, and revision rate between CKD and non-CKD groups, and between dialysis-dependent patients (dialysis group) and non-dialysis-dependent patients (non-dialysis group). Results: Eighteen studies were included in this meta-analysis. In most studies that assessed preoperative comorbidities, the number and severity of preoperative comorbidities were reported to be higher in the CKD group than in the non-CKD group. The risk of mortality was found to be higher in the CKD and dialysis groups compared with the respective control groups. In the studies based on administrative data, the unadjusted odds ratio (OR) of PJI was significantly higher in the CKD group than in the non-CKD group; however, no significant difference between the groups was noted in the adjusted OR. After total hip arthroplasty (THA), the risk of PJI was higher in the dialysis group than in the non-dialysis group. No significant difference was noted between the groups in the rate of PJI following total knee arthroplasty. The revision rate did not significantly differ between the CKD and non-CKD groups in the studies that were based on administrative data. However, the unadjusted OR was significantly higher in the dialysis group than in the non-dialysis group. Conclusions: Preoperative comorbidities and mortality risk were higher in the CKD and dialysis groups than in their respective control groups. The risk of revision was greater in the dialysis group than in the non-dialysis group, and the risk of PJI in the dialysis group became even greater after THA. Surgeons should perform careful preoperative risk stratification and optimization for patients with CKD scheduled to undergo TJA.

show abstract

Impact of Charlson indices and comorbid conditions on complication risk in bilateral simultaneous total knee arthroplasty

Cited by 33 publications

References 24 publications

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

Clinical Outcomes, Health Care Costs and Prognostic Factors for Total Knee Arthroplasty: A Multilevel Analysis of a National Cohort Study Using Administrative Claims Data

Pre-operative clinical predictors for cardiology referral prior to total joint arthroplasty: the ‘asymptomatic’ patient

Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis

Contact Info

Product

Resources

About