Inhospital Complications and Costs of Simultaneous Bilateral Total Knee Arthroplasty: The Case for Selection and Potential Cost Savings

Yakkanti, Ramakanth; Ovadia, J.; Reddy, Gireesh B.; Browne, James A.; D’Apuzzo, Michele R.

doi:10.1016/j.arth.2022.02.094

Cited by 10 publications

(5 citation statements)

References 37 publications

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“…10,11,24 Multiple studies have found lower odds of hematoma, deep infection, and major mechanical malfunction in the simBTKA compared with the stgBTKA group. 23,25,26 Many of the same studies also highlight increased rates of major complications associated with simBTKA including venous thromboembolism, pulmonary embolism, cardiac events, gastrointestinal, central nervous system, and peripheral vascular complications. 25,26 Another study reported no difference in functional improvement or pain reduction between simBTKA and stgBTKA, suggesting no substantial benefit associated with increased risk.…”

Section: Discussionmentioning

confidence: 97%

“…23,25,26 Many of the same studies also highlight increased rates of major complications associated with simBTKA including venous thromboembolism, pulmonary embolism, cardiac events, gastrointestinal, central nervous system, and peripheral vascular complications. 25,26 Another study reported no difference in functional improvement or pain reduction between simBTKA and stgBTKA, suggesting no substantial benefit associated with increased risk. 15 One of the main proposed benefits of simBTKA is decreased cost due to one hospitalization, one anesthetic event, and one recovery; however, there remains inconsistent data regarding cost savings.…”

Section: Discussionmentioning

confidence: 97%

“…While some studies note significant cost savings when comparing simBTKA to stgBTKA, many of these studies fail to include postdischarge and rehabilitation costs. 25,26 Patients undergoing simBTKA are significantly more likely to be discharged to an inpatient rehabilitation facility, which may counterbalance the cost savings by having both surgeries on the same day. 25 One study included postacute care and rehabilitation costs in the overall surgical cost comparing bilateral total joint arthroplasty (BTJA).…”

Section: Discussionmentioning

confidence: 99%

“…25,26 Patients undergoing simBTKA are significantly more likely to be discharged to an inpatient rehabilitation facility, which may counterbalance the cost savings by having both surgeries on the same day. 25 One study included postacute care and rehabilitation costs in the overall surgical cost comparing bilateral total joint arthroplasty (BTJA). They found no significant difference in cost of care between staged BTJA and simultaneous BTJA.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative Opioid Consumption is Greater after Simultaneous versus Staged Bilateral Total Knee Arthroplasty

Sustich,

Stambough,

Hui

et al. 2023

J Knee Surg

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Increased exposure to opioids around total knee arthroplasty (TKA) can lead to a risk of long-term dependence. We hypothesized that performing simultaneous bilateral total knee arthroplasty (simBTKA) over staged surgery (staged bilateral total knee arthroplasty [stgBTKA]) may decrease the total amount of opiates used. We retrospectively reviewed 29 patients who underwent simBTKAs performed between February 2015 and November 2020 and identified 23 that did not use opioids ≤90 days prior to surgery. These were frequency matched for gender and body mass index to 50 stgBTKAs completed within 6 months who also were opioid-free ≤90 days prior to their first surgery. Using our state's prescription database, we reviewed postsurgery opioid refills and morphine milligram equivalents (MMEs) for the two groups and compared their initial MME prescription at discharge and their total MME consumption 6 months postoperatively. Total MME consumption for the stgBTKA group included all prescriptions following the first and 6 months after the second surgery, whereas for the simBTKA group, total consumption included the 6 months after their two same-day surgeries. The simBTKA group had more MMEs prescribed initially (median = 375) than did the stgBTKA group after second surgery (median = 300; p < 0.007), larger postoperative-refill MMEs in the first 30 days (median = 300) than stgBTKA (median = 0; p = 0.221) and increased total MME consumption 6 months after surgery (median = 675) compared with stgBTKA after second surgery (median = 450; p = 0.077). However, both groups had similar monthly consumptions rates, with medians I MMEs/month of 112 for simBTKA versus 96 for stgBTKA (p = 0.585). Our results suggest there is no significant difference in opioid consumption between simBTKA and stgBTKA. In fact, we found that simBTKA patients received larger opioid amounts in the immediate postoperative period as well as slightly larger amounts at 30 days.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative Opioid Consumption is Greater after Simultaneous versus Staged Bilateral Total Knee Arthroplasty

Sustich,

Stambough,

Hui

et al. 2023

J Knee Surg

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“…comorbidities and greater physiological reserve, whereas StaBTKA has been performed in patients with more comorbidities. 4 However, debates concerning the clinical outcomes, healthcare utilization, and efficacy of the two methods have been ongoing. Therefore, the current study aimed to compare the clinical outcomes of the two methods at our institution.…”

mentioning

confidence: 99%

Comparison of the Cost-Effectiveness and Safety between Staged Bilateral Total Knee Arthroplasty and Simultaneous Bilateral Total Knee Arthroplasty: A Retrospective Cohort Study between 2001 and 2022

Tsui,

Chan,

Cheung

et al. 2024

J Knee Surg

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Introduction: A substantial proportion of Hong Kong’s aging population suffers from osteoarthritis in both knees. Bilateral total knee arthroplasty (BTKA) is a surgical option for addressing this condition and can be performed via two approaches: simultaneous (SimBTKA) and staged (StaBTKA) bilateral TKAs. We compared the cost-effectiveness and safety of these two methods in our institution. Methods: We retrospectively reviewed 2,372 patients (SimBTKA, 772; StaBTKA, 1,600; female, 1,780; male, 592; mean age at SimBTKA, 70.4 ± 7.99 years; mean age at StaBTKA, 66.4 ± 7.50 years; p < 0.001) who underwent bilateral TKA in our institution from 2001 to 2022. Patients were categorized according to surgical approach. Patients undergoing BTKA in our institution were included. Particularly for SimBTKA, patients were assessed by anesthetists to be medically fit before undergoing SimBTKA according to their age, American Society of Anesthesiologists status, and osteoarthritis severity. Primary outcome was the length-of-stay (LOS) after surgery. Secondary outcomes were the 30-day unintended readmission, intensive care unit (ICU) admission, and death. Results: SimBTKA had a short mean total LOS (acute hospital + rehabilitation center; SimBTKA, 13.09 days; StaBTKA, 18.12 days; p < 0.001) and mean LOS in acute hospital (SimBTKA, 7.70 days; StaBTKA, 10.42 days; p < 0.001). However, no significant difference was found in mean LOS in rehabilitation centers (SimBTKA, 5.47 days; StaBTKA, 6.32 days; p > 0.05) between the two approaches. The 30-day unintended readmission rate was low in SimBTKA (SimBTKA, 2.07%; StaBTKA, 3.30%; OR = 1.60; p > 0.05) but statistically insignificant. SimBTKA was less costly than StaBTKA by US$8,422.22. per patient. No significant differences in ICU admission and death rates were found (p > 0.05) between the two groups. Conclusion: SimBTKA had a shorter LOS and lower cost than StaBTKA and comparable complication rates. Therefore, SimBTKA should be indicated in medically stable patients. Keywords: Total knee arthroplasty, Cost-Effectiveness, Aging, Pain, Anesthesia

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Miscoding in the Nationwide Inpatient Sample Database Raises Questions About Validity for Arthroplasty Research

Adalbert,

Constantinescu,

Orton

et al. 2024

The Journal of Arthroplasty

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Inhospital Complications and Costs of Simultaneous Bilateral Total Knee Arthroplasty: The Case for Selection and Potential Cost Savings

Cited by 10 publications

References 37 publications

Postoperative Opioid Consumption is Greater after Simultaneous versus Staged Bilateral Total Knee Arthroplasty

Postoperative Opioid Consumption is Greater after Simultaneous versus Staged Bilateral Total Knee Arthroplasty

Comparison of the Cost-Effectiveness and Safety between Staged Bilateral Total Knee Arthroplasty and Simultaneous Bilateral Total Knee Arthroplasty: A Retrospective Cohort Study between 2001 and 2022

Miscoding in the Nationwide Inpatient Sample Database Raises Questions About Validity for Arthroplasty Research

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