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1.
Jakub Sikora-Klak Andrew Gupta Christopher Bergum Bradley Zarling David C. Markel 《The Journal of arthroplasty》2017,32(4):1085-1088
Background
The ability to identify those at risk for longer inpatient stay helps providers with postoperative planning and patient expectations. Decreasing length of stay (LOS) in the future will be determined by appropriate patient selection, risk stratification, and preoperative patient optimization. The purpose of this study was to identify factors that place patients at risk for extended postoperative LOSs.Methods
The study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty (THA) patients. Patient comorbidities were prospectively identified and the LOS for each patient was tracked after a primary arthroplasty. Statistical analysis was performed to correlate which comorbidities were associated with longer inpatient stays.Results
In the TKA population, gender, smoking status, venous thromboembolism history, body mass index, and diabetes status were not found to be a significant predictor for the LOS. Age was found to be a factor in univariate regression testing (P < .001). In the THA population, univariate testing showed female gender (P < .001), smoking status (P = .002), and age (P < .001) to be factors, but like the TKA population, venous thromboembolism history or diabetes status was not significant. In THA multivariate analysis, age (P < .001) and female gender (P = .018) continued to be factors, but smoking was determined to be a confounding variable.Conclusion
Age and gender were associated with a longer LOS after THA, whereas only age was a significant factor after TKA. Development of age-adjusted LOS models may help aid patient expectations and risk management. 相似文献2.
Dong-han Yao Aakash Keswani Chirag K. Shah Alex Sher Karl M. Koenig Calin S. Moucha 《The Journal of arthroplasty》2017,32(2):375-380
Background
Bundled payment programs for primary total joint arthroplasty (TJA) have identified reducing nonhome discharge as a major area of cost savings. Health care providers must therefore identify, risk stratify, and appropriately care for home-discharged TJA patients. This study aimed to analyze risk factors and timing of postdischarge complications among home-discharged primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients and risk stratify them to identify those who would benefit from higher level care.Methods
Patients discharged home after elective primary THA/TKA from 2011 to 2014 were identified in the National Surgical Quality Improvement Program database. Bivariate and multivariate analyses were performed using perioperative variables.Results
A total of 50,376 and 71,293 home-discharged THA and TKA patients were included for analysis, of which, 1575 THA (3.1%) and 2490 TKA (3.5%) patients suffered postdischarge severe complications or unplanned readmissions. These patients were older, smokers, obese, and functionally dependent (P < .001 for all). In multivariate analysis, severe adverse event predischarge, age, male gender, functional status, and 10 other variables were all associated with ≥1.22 odds of postdischarge severe adverse event or readmission (P < .05). THA and TKA patients with 2, 3, or ≥4 risk factors had 1.43-5.06 times odds of complications within 14 days post discharge and 1.41-3.68 times odds of complications beyond 14 days compared to those with 0 risk factors (P < .001 for all).Conclusion
Risk factors can be used to predict which home-discharged TJA patients are at greatest risk of postdischarge complications. Given that this is a growing population, we recommend the development of formal risk-stratification protocols for home-discharged TJA patients. 相似文献3.
P. Maxwell Courtney Anthony J. Boniello Richard A. Berger 《The Journal of arthroplasty》2017,32(5):1426-1430
Background
As outpatient total hip (THA) and knee arthroplasties (TKA) increase in popularity, concerns exist about the safety of discharging patients home the same day. The purpose of this study is to determine the complications associated with outpatient total joint arthroplasty (TJA) and to identify high-risk patients who should be excluded from these protocols.Methods
We queried the American College of Surgeons-National Surgical Quality Improvement Program database for all patients who underwent primary TKA or THA from 2011 to 2014. Demographic variables, medical comorbidities, and 30-day complication, readmission, and reoperation rates were compared between outpatient and traditional inpatient procedures. A multivariate logistic regression analysis was then performed to identify independent risk factors of poor short-term outcomes.Results
Of the total 169,406 patients who underwent TJA, 1220 were outpatient (0.7%). The outpatient and inpatient groups had an overall complication rate of 8% and 16%, respectively. Patients aged more than 70 years, those with malnutrition, cardiac history, smoking history, or diabetes mellitus are at higher risk for readmission and complications after THA and TKA (all P < .05). Surprisingly, outpatient TJA alone did not increase the risk of readmission (OR 0.652, 95% CI 0.243-1.746, P = .395) or reoperation (OR 1.168, 95% CI 0.374-3.651, P = .789), and was a negative independent risk factor for complications (OR 0.459, 95% CI 0.371-0.567, P < .001).Conclusion
With the resources available in a hospital setting, outpatient TJA may be a safe option, but only in select, healthier patients. Care should be taken to extrapolate these results to an outpatient facility, where complications may be more difficult to manage. 相似文献4.
Brian C. Werner Matthew D. Higgins Hakan C. Pehlivan Joshua T. Carothers James A. Browne 《The Journal of arthroplasty》2017,32(2):402-406
Background
Recent studies have reported higher postoperative complication rates in obese and morbidly obese patients undergoing total hip arthroplasty (THA). Less data are available regarding super-obese (body mass index [BMI] >50 kg/m2) patients. This study aims to quantify the risk of complications after THA in super-obese patients on a national scale and to put these risks in context by comparing them to patients of other BMI classes as well as those undergoing revision THA.Methods
Utilizing a national insurance database, complication rates after THA in super-obese patients (n = 3244) were compared to nonobese, obese, and morbidly obese patients undergoing primary THA and all patients undergoing revision THA. A logistic regression analysis controlling for demographic and comorbidity variables was utilized to determine the independent effect of super obesity on complication rates after THA.Results
Super-obese patients had significantly higher rates of most complications than nonobese, obese, morbidly obese, and revision THA patients, including venous thromboembolism, infection, blood transfusion, medical complications, dislocation, readmission, and revision THA.Conclusion
Super-obese patients (BMI >50 kg/m2) have higher rates of postoperative complications after THA than nonobese, obese, morbidly obese, and revision THA patients. Super obesity is an independent risk factor for increased rates of most postoperative complications including the need for early revision THA. 相似文献5.
Clement J. Michet Cathy D. Schleck Dirk R. Larson Hilal Maradit Kremers Daniel J. Berry David G. Lewallen 《The Journal of arthroplasty》2017,32(4):1292-1297
Background
While studies have demonstrated that mortality after total hip (THA) and total knee (TKA) arthroplasty is better than the general population, the causes of death are not well established. We evaluated cause-specific mortality after THA and TKA.Methods
The study included population-based cohorts of patients who underwent THA (N = 2019) and TKA (N = 2259) between 1969 and 2008. Causes of death were classified using the International Classification of Diseases 9th and 10th editions. Cause-specific standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated by comparing observed and expected mortality. Expected mortality was derived from mortality rates in the United States white population of similar calendar year, age, and sex characteristics.Results
All-cause mortality was lower than expected following both THA and TKA. However, there was excess mortality due to mental diseases such as dementia following both THA (SMR 1.40, 95% CI 1.08, 1.80) and TKA (SMR 1.49, 95% CI 1.19, 1.85). There was also excess mortality from inflammatory musculoskeletal diseases in THA (SMR 3.50, 95% CI 2.11, 5.46) and TKA (SMR 4.85, 95% CI 3.29, 6.88). When the cohorts were restricted to patients with osteoarthritis as the surgical indication, the excess risk of death from mental diseases still persisted in THA (SMR 1.36, 95% CI 1.02, 1.78) and TKA (SMR 1.52, 95% CI 1.20, 1.91).Conclusion
THA and TKA patients experience a higher risk of death from mental and inflammatory musculoskeletal diseases. These findings warrant further research to identify drivers of mortality and prevention strategies in arthroplasty patients. 相似文献6.
Joshua C. Rozell P. Maxwell Courtney Jonathan R. Dattilo Chia H. Wu Gwo Chin Lee 《The Journal of arthroplasty》2017,32(3):719-723
Background
Improved pain management and early mobilization protocols have increased interest in the feasibility of short stay (<24 hours) or outpatient total hip (THA) and total knee (TKA) arthroplasty. However, concerns exist regarding patient safety and readmissions. The purposes of this study were to determine the incidence of in-hospital complications following THA/TKA, to create a model to identify comorbidities associated with the risk of developing major complications >24 hours postoperatively, and to validate this model against another consecutive series of patients.Methods
We prospectively evaluated a consecutive series of 802 patients who underwent elective primary THA and TKA over a 9-month period. The mean age was 62.3 years. Demographic, surgical, and postoperative readmission data were entered into an arthroplasty database.Results
Of the 802 patients, 382 experienced a complication postoperatively. Of these, 152 (19%) required active management. Multiple logistic regression analysis identified cirrhosis (odds ratio [OR], 5.89; 95% confidence interval [CI], 1.05-33.07; P = .044), congestive heart failure (OR, 3.12; 95% CI, 1.50-6.44; P = .002), and chronic kidney disease (OR, 3.85; 95% CI, 2.21-6.71; P < .001) as risk factors for late complications. One comorbidity was associated with a 77% probability of developing a major postoperative complication. This model was validated against an independent dataset of 1012 patients.Conclusion
With improved pain management and mobilization protocols, there is increasing interest in short stay and outpatient THA and TKA. Patients with cirrhosis, congestive heart failure, or chronic kidney disease should be excluded from early discharge total joint arthroplasty protocols. 相似文献7.
Cameron K. Ledford Joseph M. Statz Brian P. Chalmers Kevin I. Perry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(5):1560-1564
Background
As solid organ transplant (SOT) patients' survival improves, the number undergoing total hip (THA) and total knee arthroplasty (TKA) is increasing. Accordingly, the number of revision procedures in this higher-risk group is also increasing. The goals of this study were to identify the most common failure mechanisms, associated complications, clinical outcomes, and patient survivorship of SOT patients after revision THA or TKA.Methods
A retrospective review identified 39 revision procedures (30 revision THAs and 9 revision TKAs) completed in 37 SOT patients between 2000 and 2013. The mean age at revision surgery was 62 years with a mean follow-up of 6 years.Results
The most common failure mode for revision THA was aseptic loosening (10/30, 33%), followed by periprosthetic joint infection (PJI; 7/30, 23%). The most common failure mode for revision TKA was PJI (5/9, 56%). There were 6 re-revision THAs for PJI (3/30; 10%) and instability (3/30; 10%). There were 2 reoperations after revision TKA, both for acute PJI (2/9; 22%). Final Harris Hip Scores significantly (P = .03) improved as did Knee Society Scores (P = .01). Estimated survivorship free from mortality at 5 and 10 years was 71% and 60% after revision THA and 65% and 21% after revision TKA, respectively.Conclusion
Revision THA and TKA after solid organ transplantation carry considerable risk for re-revision, particularly for PJI. Although SOT recipients demonstrate improved clinical function after revision procedures, patient survivorship at mid- to long-term follow-up is low. 相似文献8.
Steven M. Kurtz Edmund C. Lau Kevin L. Ong Edward M. Adler Frank R. Kolisek Michael T. Manley 《The Journal of arthroplasty》2017,32(11):3274-3285
Background
The purpose of this study was to determine whether the cost of readmissions after primary total hip and knee arthroplasty (THA and TKA) has decreased since the introduction of health care reform legislation and what patient, clinical, and hospital factors drive such costs.Methods
The 100% Medicare inpatient dataset was used to identify 1,654,602 primary THA and TKA procedures between 2010 and 2014. The per-patient cost of readmissions was evaluated in general linear models in which the year of surgery and patient, clinical, and hospital factors were treated as covariates in separate models for THA and TKA.Results
The year-to-year risk of 90-day readmission was reduced by 2% and 4% (P < .001) for THA and TKA, respectively. By contrast, the cost of readmissions did not change significantly over time. The 5 most important variables associated with the cost of 90-day THA readmissions (in rank order) were the nature of the readmission (ie, due to medical or procedure-related reasons), the length of stay, hospital's teaching status, discharge disposition, and hospital's overall total joint arthroplasty volume. The top 5 factors associated with the cost of 90-day TKA readmissions were (in rank order) the length of stay, hospital's teaching status, discharge disposition, patient's gender, and age.Conclusion
Although readmission rates declined slightly, the results of this study do not support the hypothesis that readmission costs have decreased since the introduction of health care reform legislation. Instead, we found that clinical and hospital factors were among the most important cost drivers. 相似文献9.
Chirag K. Shah Aakash Keswani Ben D. Boodaie Dong-Han Yao Karl M. Koenig Calin S. Moucha 《The Journal of arthroplasty》2017,32(1):246-251
Background
This study aimed at assessing short-term risk of serious cardiac events after elective total joint arthroplasty (TJA) as compared to a less-invasive procedure, knee arthroscopy (KA).Methods
Patients who underwent elective primary total hip arthroplasty (THA), total knee arthroplasty (TKA), or KA from 2011 to 2014 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. A 1:1 propensity matching was used to generate 2 control cohorts of KA patients with similar characteristics. Bivariate and multivariate analyses were assessed using perioperative variables.Results
A total of 24,203 THA, 21,740 TKA, and 45,943 KA patients were included. Bivariate analysis revealed significantly higher rates of serious 30-day cardiac events (myocardial infarction or cardiac arrest) among THA (0.15% vs 0.05%, P < .001) and TKA patients (0.14% vs 0.05%, P < .03) vs KA controls. In multivariate analysis controlling for patient characteristics and comorbidities, THA and TKA were associated with a 2.61 and 1.98 times odds of serious 30-day cardiac events as compared to controls (P ≤ .03 for both). Additional independent predictors of serious 30-day cardiac events included age, smoking, cardiac disease, and American Society of Anesthesiologists class 3/4. In the THA and TKA cohorts, serious cardiac events occurred within the first 3 days postoperation compared to 4 days in controls.Conclusion
After controlling for patient characteristics and comorbidities, TJA increased the short-term risk of serious cardiac event compared to a less-invasive procedure. This information better quantifies the risk differential for patients considering surgery as they engage in shared decision making with their providers. In addition, our data may have an impact on perioperative management of antithrombotic medications used in patients with cardiac disease. The median time in days to serious cardiac event was 2 in THA and 3 in TKA vs 4 in KA, which may have implications in postoperative monitoring of patients after surgery. 相似文献10.
P. Maxwell Courtney James I. Huddleston Richard Iorio David C. Markel 《The Journal of arthroplasty》2017,32(1):1-5
Background
Alternative payment models, such as bundled payments, aim to control rising costs for total knee arthroplasty (TKA) and total hip arthroplasty (THA). Without risk adjustment for patients who may utilize more resources, concerns exist about patient selection and access to care. The purpose of this study was to determine whether lower socioeconomic status (SES) was associated with increased resource utilization following TKA and THA.Methods
Using the Michigan Arthroplasty Registry Collaborative Quality Initiative database, we reviewed a consecutive series of 4168 primary TKA and THA patients over a 3-year period. We defined lowest SES based upon the median household income of the patient's ZIP code. Demographics, medical comorbidities, length of stay, discharge destination, and readmission rates were compared between patients of lowest SES and higher SES.Results
Patients in the lowest SES group had a longer hospital length of stay (2.79 vs 2.22 days, P < .001), were more likely to be discharged to a rehabilitation facility (27% vs 18%, P < .001), and be readmitted to the hospital within 90 days (11% vs 8%, P = .002) than the higher SES group. Multivariate analysis revealed that lowest SES was an independent risk factor for all 3 outcome variables (all P < .001).Conclusion
Patients in the lowest SES group utilize more resources in the 90-day postoperative period. Therefore, risk adjustment models, including SES, may be necessary to fairly compensate hospitals and surgeons and to avoid potential problems with access to joint arthroplasty care. 相似文献11.
Benjamin F. Ricciardi Kathryn K. Oi Steven B. Daines Yuo-Yu Lee Amethia D. Joseph Geoffrey H. Westrich 《The Journal of arthroplasty》2017,32(4):1074-1079
Background
Changes in reimbursement for total hip and knee arthroplasties (THA and TKA) have placed increased financial burden of early readmission on hospitals and surgeons. Our purpose was to characterize factors of 30-day readmission for surgical complications after THA and TKA at a single, high-volume orthopedic specialty hospital.Methods
Patients with a diagnosis of osteoarthritis and who were readmitted within 30 days of their unilateral primary THA or TKA procedure between 2010 and 2014. Readmitted patients were matched to nonreadmitted patients 1:2. Patient and perioperative variables were collected for both cohorts. A conditional logistic regression was performed to assess both the patient and perioperative factors and their predictive value toward 30-day readmission.Results
Twenty-one thousand eight hundred sixty-four arthroplasties (THA = 11,105; TKA = 10,759) were performed between 2010 and 2014 at our institution, in which 60 patients (THA = 37, TKA = 23) were readmitted during this 5-year period. The most common reasons for readmission were fracture (N = 14), infection (N = 14), and dislocation (N = 9). Thirty-day readmission for THA was associated with increased procedure time (P = .05), length of stay (LOS) shorter than 2 days (P = .04), discharge to a skilled nursing facility (P = .05), and anticoagulation use other than aspirin (P = .02). Thirty-day readmission for TKA was associated with increased tourniquet time (P = .02), LOS <3 days (P < .01), and preoperative depression (P = .02). In the combined THA/TKA model, a diagnosis of depression increased 30-day readmission (odds ratio 3.5 [1.4-8.5]; P < .01).Conclusion
Risk factors for 30-day readmission for surgical complications included short LOS, discharge destination, increased procedure/tourniquet time, potent anticoagulation use, and preoperative diagnosis of depression. A focus on risk factor modification and improved risk stratification models are necessary to optimize patient care using readmission rates as a quality benchmark. 相似文献12.
Robert A. Burnett Nicholas A. Bedard David E. DeMik Yubo Gao Steve S. Liu John J. Callaghan 《The Journal of arthroplasty》2017,32(12):3693-3697
Background
Blood transfusion guidelines in elective surgery have been implemented over the last decade to minimize risk and cost related to transfusion without sacrificing patient outcomes. Blood utilization in primary total hip (THA) and total knee arthroplasty (TKA) has been extensively studied but there is a paucity of studies evaluating utilization in revision THA and TKA. The purpose of this study is to evaluate current trends in transfusion following revision THA and TKA.Methods
The Humana dataset was reviewed for transfusion trends from 2007 to 2015 for patients undergoing revision THA and TKA. Subgroup analysis was performed to evaluate the impact of age, gender, geographic location, and obesity.Results
In total, 9176 and 12,493 revision THA and TKA patients were analyzed with transfusion rates of 19.2% and 11.9%, respectively. Allogeneic packed red blood cells were most commonly transfused (90% and 92%, respectively). Transfusion rates decreased significantly from 24.7% to 10.3% and 15.9% to 4.5%, respectively, over the years 2007-2015. Women had higher transfusion rates (odds ratio [OR] THA:TKA 1.24:1.23), while obesity was associated with lower transfusion rates after revision THA (OR 0.88). Transfusion rates were higher in 2-component revisions compared to primary (OR THA:TKA 1.24:1.24), while 1-component revisions had lower transfusion rates than primary procedures (OR THA:TKA 0.79:0.25).Conclusion
Transfusion rates after revision THA and TKA have fallen substantially since 2007. In 2016, only 10% and 4% of revision THA and TKA, respectively, required transfusion. The study should provide benchmark data for surgeons to use as comparison to the blood utilization following revision joint replacement at their institutions. 相似文献13.
Matthew W. Bullock Matthew L. Brown Daniel N. Bracey Maxwell K. Langfitt John S. Shields Jason E. Lang 《The Journal of arthroplasty》2017,32(4):1067-1073
Background
Periprosthetic joint infection (PJI) represents a devastating complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Modifiable patient risk factors as well as various intraoperative and postoperative variables have been associated with risk of PJI. In 2011, our institution formulated a “bundle” to optimize patient outcomes after THA and TKA. The purpose of this report is to describe the “bundle” protocol we implemented for primary THA and TKA patients and to analyze its impact on rates of PJI and readmission.Methods
Our bundle protocol for primary THA and TKA patients is conceptually organized about 3 chronological periods of patient care: preoperative, intraoperative, and postoperative. The institutional total joint database and electronic medical record were reviewed to identify all primary THAs and TKAs performed in the 2 years before and following implementation of the bundle. Rates of PJI and readmission were then calculated.Results
Thirteen of 908 (1.43%) TKAs performed before the bundle became infected compared to only 1 of 890 (0.11%) TKAs performed after bundle implementation (P = .0016). Ten of 641 (1.56%) THAs performed before the bundle became infected, which was not statistically different from the 4 of 675 (0.59%) THAs performed after the bundle that became infected (P = .09).Conclusion
The bundle protocol we describe significantly reduced PJIs at our institution, which we attribute to patient selection, optimization of modifiable risk factors, and our perioperative protocol. We believe the bundle concept represents a systematic way to improve patient outcomes and increase value in total joint arthroplasty. 相似文献14.
Maria A. Martínez-Huedo Rodrigo Jiménez-García Isabel Jiménez-Trujillo Valentín Hernández-Barrera Benito del Rio Lopez Ana López-de-Andrés 《The Journal of arthroplasty》2017,32(12):3729-3734.e2
Background
We aimed to compare in-hospital postoperative complications (IHPC) and in-hospital mortality between patients with and without type 2 diabetes mellitus (T2DM) undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).Methods
We analyzed data from the Spanish National Hospital Discharge Database, 2010-2014. We selected patients who had undergone THA (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 81.51) and TKA (code 81.54). Diabetic patients with THA and TKA were matched by year, age, sex, and the comorbidities included in the modified Elixhauser Comorbidity Index with a nondiabetic patient.Results
We identified 115,234 THA patients and 195,355 TKA patients, 12.4% and 15.6% with T2DM, respectively. We matched 10,777 and 26,640 pairs of diabetic and nondiabetic patients. In T2DM patients who had undergone THA, the incidence of urinary tract infection was higher than in nondiabetic patients (1.50% vs 1.09%, P = .007), as was that of “any IHPC” (9.68% vs 8.98%, P = .038). In patients who had undergone TKA, the incidence of postoperative anemia was significantly higher in diabetic patients (4.90% vs 4.53, P = .040), as was that of urinary tract infection (0.80% vs 0.53%, P = .025) and “any IHPC” (7.30% vs 6.76%, P = .014). In both procedures, mean length of hospital stay was significantly higher in diabetic patients; for TKA, in-hospital mortality was higher in diabetic patients (0.09% vs 0.02%, P = .002). Previous comorbidities, age, and obesity predict a higher incidence of IHPC among diabetic patients.Conclusions
This study confirms the higher risk of IHPC among T2DM patients after joint arthroplasty. IHPC may result in a higher risk of mortality in patients undergoing TKA. 相似文献15.
Stephen M. Petis Kevin I. Perry Mark W. Pagnano Daniel J. Berry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(11):3510-3518
Background
Prolonged retention of an antibiotic spacer is occasionally chosen during treatment of periprosthetic joint infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of our study was to evaluate the outcome of extended spacer retention.Methods
We reviewed 1106 cases of periprosthetic joint infection after THA (n = 308) and TKA (n = 798) and identified 17 (5.5%) retained hip and 34 (4.3%) retained knee spacers. Most patients (35 of 51, 69%) underwent spacer retention because they were medically unfit for further surgery. The remaining patients (16 of 51, 31%) had acceptable function and forewent further surgery. Competing risk analyses, with death as the competing risk, determined the cumulative incidence of reinfection and spacer revision. Radiographic analysis and clinical outcomes were analyzed.Results
The 2-year cumulative incidence for reinfection was 7% for retained hip and 13% for retained knee spacers. The cumulative incidence for all-cause spacer revision was 28% at 4 years for hips and 21% at 2 years for knees. The most common complications were implant migration and femoral spacer subsidence in the hip cohort, and supracondylar femur fractures and spacer dislocations in the knee cohort. The cumulative incidence for radiographic signs of mechanical failure was 72% and 87% at late follow-up for the hip and knee groups, respectively. The latest Harris Hip Score and Knee Society Score were 62 and 63, respectively.Conclusion
Antibiotic spacer retention is a rare event in the course of planned 2-stage treatment of infected THA or TKA. Failure secondary to recurrent infection is uncommon; however, failure for mechanical reasons is frequent and clinical outcomes are relatively poor. 相似文献16.
Harry A. Demos Zilan X. Lin William R. Barfield Sylvia H. Wilson Dawn C. Robertson Vincent D. Pellegrini 《The Journal of arthroplasty》2017,32(8):2375-2380
Background
Tranexamic acid (TXA) has been associated with decreased blood loss and transfusion after total hip arthroplasty (THA) and total knee arthroplasty (TKA). The purpose of this study was to examine both transfusion utilization and the economic impact of a Process Improvement Project implementing TXA for THA and TKA.Methods
After standardization of TXA administration in THA and TKA patients, retrospective data were compared from 12 consecutive months before (group A, n = 336 procedures) and after (group B, n = 436 procedures) project initiation.Results
TXA administration increased with project implementation (group A = 3.57%, group B = 86.01%) and was associated with reductions in perioperative hemoglobin decrement (20.2%), patients transfused (45%), and number of units transfused per patient (61.9%). Cost savings were notable per patient ($128) and annually program wide ($55,884) with the primary THA subgroup contributing the most to the savings. No increase in adverse effects was observed.Conclusion
Standardized administration of TXA is an effective and economically favorable blood-reduction strategy for patients undergoing elective THA or TKA. Although reduction in transfusions with TXA may be greater after TKA, the economic and clinical impact of transfusion reduction is more substantial in THA patients. 相似文献17.
Nicholas A. Bedard Andrew J. Pugely Nathan R. Lux Steve S. Liu Yubo Gao John J. Callaghan 《The Journal of arthroplasty》2017,32(3):724-727
Background
Blood conservation strategies have evolved greatly over the last 5 years. There is a paucity of large blood utilization studies of total hip arthroplasty (THA) and total knee arthroplasty (TKA) that include recently performed surgery. The purpose of this study was to use a large database to evaluate trends in blood transfusion after THA and TKA, including 2015 data.Methods
The Humana data set was reviewed from 2007 to the third quarter of 2015 for all patients undergoing primary THA and TKA. Rates and type of postoperative blood transfusion were trended through the years of the data set. Further subgroup analysis was performed to evaluate the impact of patients' age, gender, geographic location, and obesity on the incidence of blood transfusion using standard statistical techniques.Results
In total, 69,350 THA patients and 139,804 TKA patients were analyzed. Overall transfusion rate was 18.2% and 12.7% after TKA and THA, respectively. The most common type of blood transfused was allogeneic packed red blood cells (88% of all transfusions) followed by perioperative collected autologous blood (12% of all transfusions). There were no transfusions of preoperatively collected autologous blood. Transfusion rates decreased significantly from 21.3%-8.7% and 17.3%-4.4% for THA and TKA, respectively, over the years 2007-2015 (P < .001).Conclusion
Rates of blood transfusion after primary THA and TKA have fallen precipitously since 2010 and are now down to 9% and 4% for THA and TKA, respectively. Blood management strategies instituted over the last 5 years have had a large impact on transfusion rates after joint arthroplasty. 相似文献18.
Kurt G. Seagrave Anders Troelsen Bjørn G. Madsen Henrik Husted Thomas Kallemose Kirill Gromov 《The Journal of arthroplasty》2017,32(10):3141-3146
Background
Hip dislocation is one of the most common postoperative complications after total hip arthroplasty (THA). Potential contributors include patient- and surgical-related factors. We performed a retrospective cohort study to identify risk factors for postoperative dislocation in patients receiving THA via the posterolateral approach.Methods
We assessed 1326 consecutive primary THAs performed between 2010 and 2015. Patient information was documented, and plain radiographic films were used to evaluate cup positioning, hip offset, and hip length change. A multiple logistic regression was used to identify risk factors for dislocation. Follow-up was coordinated by the Danish National Patient Registry.Results
Age and American Society of Anesthesiologists scores were higher in dislocating THA compared with those in the nondislocating THA. Cup anteversion was less in dislocating THA compared with that in nondislocating THA. Independent risk factors for cup dislocation were increased age, body mass index <25 and >30 kg/m2, and leg shortening of >5 mm.Conclusion
Surgeons should aim for a shortening of leg length <5 mm to reduce the risk of postoperative dislocation in primary THA. Although anteversion was reduced for dislocating THA, there is likely no universal safe zone for cup positioning. Hip stability is multifactorial, and optimal cup positioning may vary from patient to patient. 相似文献19.
Hongyi Shao Chi-Lung Chen Mitchell G. Maltenfort Camilo Restrepo Richard H. Rothman Antonia F. Chen 《The Journal of arthroplasty》2017,32(2):689-695
Background
Total hip arthroplasty (THA) is one of the most successful orthopedic surgeries performed in the last 50 years. However, controversies still exist between conducting 1- or 2-stage bilateral THA.Methods
Using PubMed, Ovid, Embase, and Cochrane library databases, we searched for papers written between January 1995 and October 2015 that contained the following search terms: “one-stage or two-stage” or “simultaneous or staged,” and “hip” and “arthroplasty or replacement.” A meta-analysis was conducted with the collected pooled data about major and minor systemic complications, surgical complications, and other perioperative data associated with 1- and 2-stage bilateral THA. Statistical analysis was performed by the Mantel-Haenszel method, and the fixed effect model was used to analyze data.Results
There were 13 studies with 17,762 patients who underwent 1-stage bilateral THA and 46,147 patients who underwent 2-stage bilateral THA. One-stage bilateral THA had a lower risk of major systemic complications, less deep venous thrombosis, and shorter operative time compared with 2-stage bilateral THA. There were no significant differences in death, pulmonary embolism, cardiovascular complication, infections, minor complications, and other surgical complications between procedures.Conclusion
One-stage bilateral THA was superior to 2-stage bilateral THA in terms of major systemic complication, deep venous thrombosis, and surgical time compared with 2-stage bilateral THA. However, this study does not encourage performing 1-stage over 2-stage bilateral THA. Higher evidence level studies are necessary for further analysis. 相似文献20.
Signe E. Andreasen Henriette B. Holm Mira Jørgensen Kirill Gromov Per Kjærsgaard-Andersen Henrik Husted 《The Journal of arthroplasty》2017,32(6):1747-1755