Thirty-Day Postoperative Complications and Mortality Following Total Knee Arthroplasty

Belmont, Philip J.; Goodman, Gens P.; Waterman, Brian R.; Bader, Julia; Schoenfeld, Andrew J.

doi:10.2106/jbjs.m.00018

Cited by 379 publications

(280 citation statements)

References 42 publications

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“…Moreover, chronic obstructive pulmonary disease recently was shown to be associated with carotid artery wall thickening, placing patients at greater danger for ischemic events [21]. Furthermore, advanced operative time has been linked to numerous postoperative adverse events after orthopaedic surgery, potentially owing to the effect of anesthesia time or to a more complicated procedure [3,36]. An important difference in the results of our study with those of Mortazavi et al [29] is that general anesthesia was not independently associated with CVA.…”

Section: Discussioncontrasting

confidence: 63%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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Background Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. Questions/purposes Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures. Methods Patients undergoing elective TKA, THA, posterior or posterolateral lumbar fusion, anterior cervical discectomy and fusion, and total shoulder arthroplasty, from 2006 to 2012, were identified from the American College of Surgeons National Surgical Quality Improvement Program 1 database. A total of 42,150 patients met inclusion criteria. Thirty-day CVA rates were recorded for each procedure, and patients were assessed for characteristics associated with CVA through univariate analysis. Multivariate regression models were created to identify independent risk factors for CVA. Results A total of 55 (0.13%) patients experienced a CVA within 30 days of the procedure, occurring a median of 2 days after surgery (range, 1-30 days) with 0.08% of patients experiencing a CVA after TKA, 0.15% after THA, 0.00% after single-level anterior cervical discectomy and fusion, 0.38% after multilevel anterior cervical discectomy and fusions, 0.20% after single-level posterior or posterolateral lumbar fusion, 0.70% after multilevel posterior or posterolateral lumbar fusion, and 0.22% after total shoulder arthroplasty. Independent risk factors for CVA included age of 75 years or older (odds ratio [OR], 2.50; 95% CI,

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Section: Discussioncontrasting

confidence: 63%

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

Minhas

Goyal

Patel

2016

Clinical Orthopaedics &Amp; Related Research

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“…Postoperative variables including length of stay as well as 30-day complication rates and mortality were calculated ( Table 2). Complications were categorized based upon the previous reports [4]. Major systemic complications included pulmonary embolism (PE), acute renal failure, cardiac arrest or myocardial infarction, sepsis or septic shock, stroke, unplanned intubation, coma over 72 h, or death.…”

Section: Methodsmentioning

confidence: 99%

An Analysis of Risk Factors for Short-Term Complication Rates and Increased Length of Stay following Unicompartmental Knee Arthroplasty

Haughom

Schairer

Hellman

et al. 2015

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Unicompartmental knee arthroplasty (UKA) is an increasingly popular procedure, with excellent long-term outcomes. However, there are only a limited number of reports reporting its short-term morbidity and mortality. Questions/Purposes: We sought to analyze the reported 30-day morbidity, mortality, and risk factors for complications and prolonged length of stay (>4 days) following UKA. Patients and Methods: Utilizing the National Surgical Quality Improvement Program (NSQIP) database, including patients (n=2316) from 2005-2012, we correlated the reported 30-day complications and prolonged length of stay with patient demographics and risk factors. Results: The overall rate of complications was low (3.2%). The distribution of complications demonstrated 0.5% major systemic, 1.4% minor systemic, 0.7% major local, and 0.9% minor local complications, with a 2.1% readmission rate. Multivariate regression demonstrated increased BMI and a history of chronic obstructive pulmonary disease (COPD) as independent risk factors for complications. Furthermore, multivariate regression demonstrated increased BMI, ASA ≥ 3, history of COPD, recent operation, and postoperative transfusion as independent risk factors for prolonged length of hospitalization. Conclusions: Utilizing the NSQIP, we present one of the largest studies to date evaluating complications following UKA. Our multivariate model demonstrated obesity and COPD to be the risk factors for complications while obesity, ASA≥3, COPD, recent operation, and blood transfusion to be the risk factors for prolonged length of stay.

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“…Diabetes mellitus (DM) is one of the most common and important diseases thought to be associated with an increased risk of perioperative complications among patients undergoing TKA. Previous studies have reported higher rates of infection [8,18,20,21,28], wound complications [5,6], greater risk of deep vein thrombosis [27,29], poorer outcomes [4,13,14,22,25], and higher mortality [2] in patients with DM undergoing TKA compared with patients without DM. Unfortunately, the prevalence of DM among patients undergoing TKA has been steadily increasing [11,15] and orthopaedic surgeons will be faced with a growing number of surgical patients with DM.…”

Section: Introductionmentioning

confidence: 99%

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

109

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Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

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Thirty-Day Postoperative Complications and Mortality Following Total Knee Arthroplasty

Abstract: Patient age and diabetes increased the risk of mortality after primary total unilateral knee arthroplasty. Predictive factors impacting the development of postoperative complications included an ASA classification of ≥3, increased operative time, increased age, and greater body mass.

Cited by 379 publications

References 42 publications

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

What are the Risk Factors for Cerebrovascular Accidents After Elective Orthopaedic Surgery?

An Analysis of Risk Factors for Short-Term Complication Rates and Increased Length of Stay following Unicompartmental Knee Arthroplasty

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

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