In Hospital Complications After Total Joint Arthroplasty

Pulido, Luis; Parvızı, Javad; Macgibeny, Margaret; Sharkey, Peter F.; Purtill, James J.; Rothman, Richard H.; Hozack, William J.

doi:10.1016/j.arth.2008.05.011

Cited by 220 publications

(161 citation statements)

References 19 publications

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“…We purposefully used propensity score matching and multivariate analysis to account for those variables. Second, our PE rate is comparable to those reported in the literature [3,26,35]. However, even with meticulous chart review, it is possible that we still missed patients who presented with PE to outside hospitals.…”

Section: Discussionsupporting

confidence: 74%

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Raphael

Tischler

Huang

et al. 2013

Clin Orthop Relat Res

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Background The most effective agent for prophylaxis against venous thromboembolic disease after total joint arthroplasty (TJA) remains unknown. The paucity of literature comparing different methods of pulmonary embolism (PE) prophylaxis and fear of litigation make it difficult for surgeons to abandon the use of aggressive chemical prophylaxis. Questions/purposes We compared the (1) overall frequency of symptomatic PE, (2) risk of symptomatic PE after propensity matching that adjusted for potentially confounding variables, and (3) other complications and length of stay before and after propensity matching in patients undergoing TJA at our institution who received either aspirin or warfarin prophylaxis. Methods A total of 28,923 patients underwent TJA between

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Section: Discussionsupporting

confidence: 74%

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Raphael

Tischler

Huang

et al. 2013

Clin Orthop Relat Res

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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%

“…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

249

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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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“…By 2009, the use of TKA had almost doubled from a decade earlier [3], and rates of both primary and revision TKA are expected to continue to increase exponentially during the next several decades [13]. Although considered a safe and effective procedure, complications associated with TKA can lead to poor outcomes [19]. As the population ages, more patients will have comorbid medical problems that may increase their risk of complications.…”

Section: Introductionmentioning

confidence: 99%

What Are the Rates and Causes of Hospital Readmission After Total Knee Arthroplasty?

Schairer

Vail

Bozic

2014

Clinical Orthopaedics &Amp; Related Research

207

142

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Background Total knee arthroplasty (TKA) and related interventions such as revision TKA and the treatment of infected TKAs are commonly performed procedures. Hospital readmission rates are used to measure hospital performance, but risk factors (both medical and surgical) for readmission after TKA, revision TKA, and treatment for the infected TKA have not been well characterized. Questions/purposes We measured (1) the unplanned hospital readmission rate in primary TKA and revision TKA, including antibiotic-spacer staged revision TKA to treat infection. We also evaluated (2) the medical and surgical causes of readmission and (3) risk factors associated with unplanned hospital readmission. Methods This retrospective cohort study included a total of 1408 patients (1032 primary TKAs, 262 revision TKAs, 113 revision of infected TKAs) from one institution. All hospital readmissions within 90 days of discharge were evaluated for timing and cause. Diagnoses at readmission were categorized as surgical or medical. Readmission risk was assessed using a Cox proportional hazards model that incorporated patient demographics and medical comorbidities. Results The unplanned readmission rate for the entire cohort was 4% at 30 days and 8% at 90 days. At 90 days postoperatively, revision of an infected TKA had the highest readmission rate, followed by revision TKA, with primary TKA having the lowest rate. Approximately threefourths of readmissions were the result of surgical causes, mostly infection, arthrofibrosis, and cellulitis, whereas the remainder of readmissions were the result of medical causes. Procedure type (primary TKA versus revision TKA or staged treatment for infected TKA), hospital stay more than 5 days, discharge destination, and a fluid/electrolyte abnormality were each associated with risk of unplanned readmission.

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In Hospital Complications After Total Joint Arthroplasty

Cited by 220 publications

References 19 publications

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

Risk of Subsequent Revision after Primary and Revision Total Joint Arthroplasty

What Are the Rates and Causes of Hospital Readmission After Total Knee Arthroplasty?

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