Incidence, Causes, and Timing of 30-Day Readmission Following Total Knee Arthroplasty

Curtis, Gannon L.; Jawad, Michael; Samuel, Linsen T.; George, Jaiben; Higuera-Rueda, Carlos A.; Little, Bryan E.; Darwiche, Hussein F.

doi:10.1016/j.arth.2019.06.009

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…However, complications such as oozing, infection, and poor healing can occur in surgical incisions due to the presence of coexisting diseases or other risk factors in patients, and the most significant adverse consequences of incisional complications are increased additional treatment costs and prolonged recovery time for patients. [ 13 , 14 ] The chances of postoperative SSIs occurring in joint arthroplasty are small, with infection rates ranging from 0.70 to 4.15%,[ 15 - 18 ] and similar results were found in our metaanalysis of about 2% of postoperative infections after joint arthroplasty. However, once infection occurs, the consequences would be catastrophic.…”

Section: Discussionsupporting

confidence: 83%

“…However, complications such as oozing, infection, and poor healing can occur in surgical incisions due to the presence of coexisting diseases or other risk factors in patients, and the most significant adverse consequences of incisional complications are increased additional treatment costs and prolonged recovery time for patients. [13,14] The chances of [10] 2019 Sprowson AP, et al [11] 2018 Lin SJ, et al [12] 2018 FIGURE 3. Risk of bias in the included literature.…”

Section: Discussionmentioning

confidence: 99%

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The role of triclosan-coated suture in preventing surgical infection: A meta-analysis

Liu

Chen

et al. 2023

Jt Dis Relat Surg

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Surgical site infection (SSI) is a severe postoperative adverse event that not only increases the cost of treatment, but also prolongs the recovery time and pain of patients. It usually occurs due to the destruction of bone tissue structure and implantation of internal fixation during orthopedic surgery. [1,2] All surgeries are classified into four categories according to the wound classification system: clean, clean/contaminated, contaminated, and dirty. [3] Hip and knee arthroplasty is a type of clean operation in orthopedics; that is, the surgical incision does not involve inflammatory areas, respiratory tract, digestive tract, and urogenital tract. [4] In general, after the strict aseptic operation and preventive use of antibiotics, the probability of postoperative infection is low. However, once an infection occurs, the consequences would be catastrophic. During surgical procedures, various species of germs have the potential to colonize not only the tissue in the surgical area, but also the sutures. [5,6] Objectives: In this meta-analysis, we aimed to compare the differences in surgical site infection (SSI) between triclosancoated and uncoated sutures after hip and knee arthroplasty. Patients and methods:We searched PubMed, Embase, and Cochrane databases for randomized-controlled studies (RCTs) comparing triclosan-coated sutures with uncoated sutures for the prevention of SSIs after hip and knee arthroplasty. Literature screening and data curation were performed according to inclusion and exclusion criteria and the risk of bias was assessed for included research using Cochrane Handbook criteria.Results: Three RCTs with a total of 2,689 cases were finally included, including 1,296 cases in the triclosan-coated suture group and 1,393 cases in the control group. The overall incidence of SSI was lower in the group with triclosan antimicrobial sutures (1.9%) than in the uncoated suture group (2.5%), but the difference was statistically significant (odds ratio=0.76, 95% confidence interval: [0.45-1.27], p=0.30). The differences in the results of the incidence of superficial SSI and deep SSI were not statistically significant (p>0.05). Conclusion:The application of triclosan antimicrobial sutures did not reduce the incidence of SSI after hip and knee arthroplasty compared to the controls, and it needs further high-quality RCT studies to be improved.

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Section: Discussionsupporting

confidence: 83%

“…However, complications such as oozing, infection, and poor healing can occur in surgical incisions due to the presence of coexisting diseases or other risk factors in patients, and the most significant adverse consequences of incisional complications are increased additional treatment costs and prolonged recovery time for patients. [13,14] The chances of [10] 2019 Sprowson AP, et al [11] 2018 Lin SJ, et al [12] 2018 FIGURE 3. Risk of bias in the included literature.…”

Section: Discussionmentioning

confidence: 99%

The role of triclosan-coated suture in preventing surgical infection: A meta-analysis

Liu

Chen

et al. 2023

Jt Dis Relat Surg

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“…Hospital readmissions (3.8%) and 30-day postoperative complications (6.5%) reflects quality of early recovery and result in fewer days spent at home/with family. Both variables are contained in DAH 30 and both were similar to international data [18,[22][23][24]. However, our joint revisions accounted for 2.7% of the complications (three S8 for reporting of missing data joint dislocations following THA (3.4%) and two infections following TKA (2.1%)) which is greater than 30-day THA and TKA data from HICs [17,22].…”

Section: The Quality Postoperative Recovery For Tha and Tka Patientssupporting

confidence: 67%

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Plenge

Parker

Davids

et al. 2020

BMC Musculoskelet Disord

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Background Encouraged by the widespread adoption of enhanced recovery protocols (ERPs) for elective total hip and knee arthroplasty (THA/TKA) in high-income countries, our nationwide multidisciplinary research group first performed a Delphi study to establish the framework for a unified ERP for THA/TKA in South Africa. The objectives of this second phase of changing practice were to document quality of patient recovery, record patient characteristics and audit standard perioperative practice. Methods From May to December 2018, nine South African public hospitals conducted a 10-week prospective observational study of patients undergoing THA/TKA. The primary outcome was ‘days alive and at home up to 30 days after surgery’ (DAH30) as a patient-centred measure of quality of recovery incorporating early death, hospital length of stay (LOS), discharge destination and readmission during the first 30 days after surgery. Preoperative patient characteristics and perioperative care were documented to audit practice. Results Twenty-one (10.1%) out of 207 enrolled patients had their surgery cancelled or postponed resulting in 186 study patients. No fatalities were recorded, median LOS was 4 (inter-quartile-range (IQR), 3–5) days and 30-day readmission rate was 3.8%, leading to a median DAH30 of 26 (25–27) days. Forty patients (21.5%) had pre-existing anaemia and 24 (12.9%) were morbidly obese. In the preoperative period, standard care involved assessment in an optimisation clinic, multidisciplinary education and full-body antiseptic wash for 67 (36.2%), 74 (40.0%) and 55 (30.1%) patients, respectively. On the first postoperative day, out-of-bed mobilisation was achieved by 69 (38.1%) patients while multimodal analgesic regimens (paracetamol and Non-Steroid-Anti-Inflammatory-Drugs) were administered to 29 patients (16.0%). Conclusion Quality of recovery measured by a median DAH30 of 26 days justifies performance of THA/TKA in South African public hospitals. That said, perioperative practice, including optimisation of modifiable risk factors, lacked standardisation suggesting that quality of patient care and postoperative recovery may improve with implementation of ERP principles. Notwithstanding the limited resources available, we anticipate that a change of practice for THA/TKA is feasible if ‘buy-in’ from the involved multidisciplinary units is obtained in the next phase of our nationwide ERP initiative. Trial registration The study was registered with ClinicalTrials.gov (NCT03540667).

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“…The overall 30-day readmission rate was 3.6%, which is consistent with previous reports. 17 No notable differences between racial/ethnic or LOS groups were detected.…”

Section: Discussionmentioning

confidence: 93%

Black and Hispanic Patients Do Not Stay Longer After Primary Total Knee Arthroplasty: Results From an Urban Center Serving a Predominantly Minority Cohort

Zvi

Sharfman

Loloi

et al. 2022

J Am Acad Orthop Surg

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Introduction: Previous reports identified minority race/ethnicity to be an independent risk factor for prolonged length of stay (LOS); however, these cohorts consisted of predominantly White patients. This study sought to evaluate minority status as an independent risk factor for prolonged LOS after primary total knee arthroplasty (TKA) in a predominantly Hispanic and Black cohort. Methods: This was a retrospective study using an institutional database of patients who underwent primary TKA between the years 2016 and 2019. Demographic and socioeconomic data, smoking, body mass index (BMI), medical comorbidities, discharge disposition, and 30-day readmission rates were collected. Patients were first categorized into racial/ethnic groups (Hispanic, Black, or White). An univariate analysis was performed comparing patient characteristics between racial/ethnic groups using the Wilcoxon rank sum, chisquared, and Fisher exact tests. We then categorized patients into two groups-normal LOS (discharged on postoperative day 1 to 2) and prolonged LOS (discharged after postoperative day 2). An univariate analysis was again performed comparing patient characteristics between LOS groups using Wilcoxon rank sum, chi-squared, and Fisher exact tests. After identifying risk factors markedly associated with LOS, a multivariate logistic regression analysis was performed to identify independent risk factors for prolonged LOS. Results: A total of 3,093 patients were included-47.9% Hispanic and 38.3% Black. Mean LOS was 2.9 6 1.6 days. An univariate analysis found race/ethnicity, age, low socioeconomic status (SES), discharge disposition, insurance type, weekday of surgery, BMI .40, smoking, increased American Society of Anesthesiologists (ASA)/Charlson Comorbidity Index (CCI) and several medical comorbidities to be associated with prolonged LOS (P , 0.05). A multivariate logistic

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Incidence, Causes, and Timing of 30-Day Readmission Following Total Knee Arthroplasty

Cited by 16 publications

References 19 publications

The role of triclosan-coated suture in preventing surgical infection: A meta-analysis

The role of triclosan-coated suture in preventing surgical infection: A meta-analysis

Quality of recovery after total hip and knee arthroplasty in South Africa: a national prospective observational cohort study

Black and Hispanic Patients Do Not Stay Longer After Primary Total Knee Arthroplasty: Results From an Urban Center Serving a Predominantly Minority Cohort

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