The Patient’s Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA

Koh, In Jun; Kim, Geon-Hyeong; Kong, Chae-Gwan; Park, Se-Wook; Park, Tae Yong; In, Yong

doi:10.1016/j.arth.2014.12.004

Cited by 25 publications

(23 citation statements)

References 42 publications

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“…The reasons for limiting this systematic review to studies published in 2008 and onwards, as well as those with at least 50% of surgeries occurring since 2008 are two-fold. Firstly, significant improvements in surgical techniques [25, 38, 39], implant technology [39, 40], peri-operative [41] and post-surgical management [40], changes in anaesthetic practices [42–45], and the introduction of ‘fast-track’ hip and knee arthroplasty [42, 44, 46] and same-day bilateral arthroplasty have occurred over the past decade [47]. Secondly, THA and TKA are increasingly performed in older patients as life expectancy increases [14, 39, 41], and those with a greater burden of medical comorbidities including obesity, diabetes, and hypertension [5, 43, 48].…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

et al. 2019

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BackgroundCardiac complication represents a major cause of morbidity and mortality after total joint arthroplasty, thus necessitating investigation into the associated risks in total hip arthroplasty and total knee arthroplasty. There remains a lack of clarity for many risk factors in the current literature. The aim of this systematic review is to assess the most recent published literature and identify the risk factors associated with cardiac complication in total hip arthroplasty and total knee arthroplasty.MethodsScopus, PubMed, CINHAL, and Cochrane were searched to identify studies published since 2008 reporting on risk factors associated with cardiac complication in elective primary in total hip arthroplasty and total knee arthroplasty in patients ≥18 years old with osteoarthritis. Reported odds ratios, hazard ratios, and relative risk were the principal summary measures collected. The included studies were too heterogeneous to enable meta-analysis.ResultsFifteen studies were included in this systematic review. Increasing age and history of cardiac disease were found by most studies to be positively associated with risk of cardiac complication. There was no strong association found between obesity and cardiac complication. The evidence for other risk factors was less clear in the examined literature, although there is suggestive evidence for male gender and cerebrovascular disease increasing risk.ConclusionsIncreasing age and history of cardiac disease increases the risk of cardiac complication after total hip arthroplasty and total knee arthroplasty. Other risk factors commonly attributed to increased risk in non-cardiac surgery including hypertension and obesity require further evaluation in arthroplasty.Systematic review registrationA detailed protocol was published in the PROSPERO database (registration number CRD42018095887) for this systematic review.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-1058-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

et al. 2019

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“…Despite presenting with a lower BMI, patients with advanced age commonly have a greater number of systemic comorbidities, some of which have been identified as more important predictors of perioperative risk and mortality compared with absolute age. 8,9,20 Specifically, Koh et al 20 reported an ASA 3 increased the risk of major postoperative complications. Age over 75 years old was also found to increase the risk of minor postoperative complications, however, neither age nor ASA 3 was found to increase the risk between unilateral and bilateral procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research evaluating complications following ssBTKA in elderly patients often report higher rates of perioperative complications including the occurrence of thromboembolic events, transfusions, infections, and mortality. 3,[12][13][14][15][16] However, these evaluations have compared ssBTKA to unilateral or staged bilateral procedures among a targeted age group, 9,[11][12][13][14][16][17][18][19][20] limiting the ability to determine the influence of age on a specific procedure. As a result, the safety of ssBTKA for elderly individuals as compared with younger patients remains unclear.…”

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confidence: 99%

Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty

et al. 2021

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Single-stage bilateral total knee arthroplasty (ssBTKA) can be used for patients presenting with bilateral arthritis and may result in fewer systemic and wound complications compared with two, independent procedures. However, the safety of ssBTKA in the elderly remains controversial. Therefore, the purpose of this study was to compare early complications and transfusion rates following ssBTKA in patients ≤ 70 years old or > 70 years old. This retrospective chart review of 313 consecutive patients undergoing ssBTKA included 174 patients ≤ 70 years old and 139 patients > 70 years old. Perioperative variables and postoperative complications were compared with univariate analyses between age groups. Multivariate analyses were performed to determine risk factors for developing perioperative complications and transfusions. Compared with patients ≤ 70, patients > 70 had significantly lower body mass index (p < 0.001) and were more commonly female (p = 0.024). Although wound (p > 0.12) and systemic complications (p > 0.54) were similar, 23% of patients > 70 required transfusion compared with only 8% of patients ≤ 70 (p < 0.001). Patients with preoperative anemia (p < 0.001), age > 70 (p = 0.002), or diabetes mellitus (p = 0.007) were at 5.7, 3.3, and 2.9 times greater risk for requiring a transfusion, respectively. Patients > 70 undergoing ssBTKA have a similar complication profile to patients ≤ 70 years old, suggesting age should not be an absolute exclusion criterion for ssBTKA. However, the risk of transfusion was significantly higher in those > 70, despite lower tourniquet times. Treatment of preoperative anemia may decrease the risk of transfusion and could provide adequate safety for patients > 70 to undergo ssBTKA by an experienced surgeon.

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“…Following BTKA, morbidity risk factors have been already studied. 9,[25][26][27] However, blood transfusion type as a risk factor for complications has not been evaluated yet. To the best of our knowledge, present study is the first who directly compares the development of systemic major or minor and local complication between patient groups receiving pure autologous, pure allogeneic or combined transfusion in a same-day BTKA cohort.…”

Section: Discussionmentioning

confidence: 99%

Does blood transfusion type affect complication and length of stay following same-day bilateral total knee arthroplasty?

Soranoglou

Poultsides

Wanivenhaus

et al. 2018

Journal of Orthopaedics

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Same-day Bilateral Total Knee Arthroplasty (BTKA) safety is still controversial. The aim of this study was to examine the association of blood transfusion type (pure autologous, pure allogeneic, and combined) with complication and prolonged length of stay (PLOS) following same-day BTKA. 649 consecutive patients were retrospectively identified over a two-year period. Pure allogeneic transfusions were associated with increased odds of minor complication when compared to patients who had pure autologous transfusions. No association was found between blood transfusion type and major complication or PLOS. Our results suggest that blood transfusion type may be influential in minor complication after BTKA.

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The Patient’s Age and American Society of Anesthesiologists Status Are Reasonable Criteria for Deciding Whether to Perform Same-Day Bilateral TKA

Cited by 25 publications

References 42 publications

Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

Perioperative Complications in Patients over 70 Years of Age following Simultaneous Bilateral Total Knee Arthroplasty

Does blood transfusion type affect complication and length of stay following same-day bilateral total knee arthroplasty?

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