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1.
Patawut Bovonratwet Nathaniel T. Ondeck Stephen J. Nelson Jonathan J. Cui Matthew L. Webb Jonathan N. Grauer 《The Journal of arthroplasty》2017,32(6):1773-1778
Background
There has been a recent surge of interest in performing primary total knee arthroplasty (TKA) in the outpatient setting to reduce cost and increase patient satisfaction. Detailed information on the safety of outpatient TKA in large sample sizes is scarce.Methods
Patients who underwent primary, elective TKA were identified in the 2005-2014 American College of Surgeons National Surgical Quality Improvement Program database. Outpatient procedure was defined as having a hospital length of stay of 0 days, whereas inpatient procedure was defined as having a length of stay ≥1 days. To reduce the effect of confounding factors and nonrandom assignment of treatment, propensity score matching was used. Multivariate analyses on the matched samples were used to compare the rates of adverse events that happened any time during the 30-day postoperative period, postdischarge adverse events, and readmissions between the outpatient and inpatient cohorts.Results
A total of 112,922 TKA patients met the inclusion criteria. Of these, only 642 (0.57%) were outpatient procedures. Outpatients tended to be men, slightly younger, and have less comorbidity. After propensity matching, multivariate analysis revealed a higher rate of postdischarge blood transfusions (P < .001) in the outpatient cohort. There were no other significant differences in 30-day postoperative individual adverse events or readmissions.Conclusion
Based on the perioperative outcome measures studied here, outpatient TKA can be appropriately considered in select patients based on rates of overall perioperative adverse events and readmissions. However, higher surveillance of these patients postdischarge may be warranted. 相似文献2.
Joseph E. Tanenbaum Derrick M. Knapik Steven J. Fitzgerald Randall E. Marcus 《The Journal of arthroplasty》2017,32(10):2941-2946
Background
The Centers for Medicare and Medicaid Services (CMS) characterizes adverse quality events in the inpatient setting as patient safety indicators (PSI). The incidence of PSI has not been quantified in the total knee arthroplasty (TKA) population.Methods
All patients in the Nationwide Inpatient Sample who underwent primary TKA during an inpatient episode in 2013 were identified using International Classification of Disease, Ninth Revision, Clinical Modification codes. The incidence of PSI was determined using the International Classification of Disease, Ninth Revision diagnosis code algorithms used by CMS. Multivariable logistic regression was used to determine significant associations between patient level covariates (demographics, comorbidities, and hospital characteristics) and the risk of experiencing one or more PSI after TKA.Results
We identified 132,453 primary TKA patients in the Nationwide Inpatient Sample in 2013. We estimated the national incidence rate of experiencing one or more PSI as 0.98%. After adjusting for patient demographics and hospital characteristics, we found that relative to Medicaid/self-pay patients, neither Medicare nor privately insured patients faced significantly different risk of experiencing one or more PSI after TKA. However, alcohol abuse, deficiency anemia, congestive heart failure, coagulopathy, and electrolyte imbalance were associated with increased risk of experiencing one or more PSI after TKA.Conclusion
The national incidence of PSI among TKA patients was lower than has been reported in other surgical populations. CMS uses the incidence of adverse quality events (measured using PSI) in part to determine hospital reimbursement. As value-based payment becomes more widely adopted in the United States, initiatives designed to eliminate and reduce PSI incidence can benefit vulnerable patient populations, physicians, and hospital systems. 相似文献3.
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4.
Effects of ethyl chloride spray on early recovery after total knee arthroplasty: A prospective study
Wang Rui Gong Long Geng Li Yu Yang Li Hengjin Wang Zhenhu 《Journal of orthopaedic science》2017,22(1):89-93
Background
Ethyl chloride spray as a common cooling modality has been widely used in acute sports injuries and joint injection procedures. Several clinical studies reported that use of ethyl chloride has positive effects on swelling, pain reduction and recovery from sports injuries. The main aim of present study was to analyze whether postoperative use of ethyl chloride spray benefits results after primary total knee arthroplasty (TKA).Methods
Between April 1, 2014 and October 21, 2015, 306 subjects undergoing primary TKA used ethyl chloride spray for improving recovery from the damage from surgery. After exclusion of 31 subjects due to adverse events including periprosthetic joint infection (PJI), deep venous thrombosis (DVT), acute myocardial infarction, finally 275 subjects' data regarding pain score, knee range of motion (ROM), knee girth, time of being able to reach 90° knee flexion and analgesic consumption were analyzed.Results
Significant differences in pain score, knee ROM at each time point and knee girth at on 21st and 28th postoperatively were detected without increased incidence of adverse events. Besides, time of being able to reach 90° knee flexion and analgesic consumption in the treatment group were significantly decreased in comparison to the control group.Conclusion
Use of ethyl chloride spray can help patients recovery from the damage from TKA safely. 相似文献5.
Masahiro Hasegawa Shinichi Miyazaki Toshio Yamaguchi Hiroki Wakabayashi Akihiro Sudo 《The Journal of arthroplasty》2017,32(1):43-46
Background
Minimally invasive surgery (MIS) has perceived advantages in the early postoperative stage for total knee arthroplasty (TKA). It is not clear whether the improved radiographic alignment achieved by computer-assisted navigation surgery (CAS) improves midterm clinical outcomes. The aim of this study was to compare patient outcomes of MIS TKA performed with and without CAS after a minimum follow-up of 7 years.Methods
Between 2007 and 2009, 50 patients underwent CAS and MIS TKA, and 50 patients underwent jig-based MIS TKA in this prospective study. Ninety-six patients were evaluated after a mean follow-up of 7.7 years, and clinical and radiological evaluations were performed.Results
Midterm results demonstrated that the Knee Society knee score, function score, and range of motion were comparable in the 2 groups. The percentage of patients with the mechanical axis within ±3° of neutral was significantly higher in the CAS group than in the jig-based group (94% vs 79%, respectively; P = .038). No knees had loosening after TKA. However, 1 patient in the CAS group demonstrated late infection 4 years postoperatively.Conclusion
CAS did not improve midterm outcomes after MIS TKA compared with jig-based surgery, although CAS reduced outliers in coronal alignment. 相似文献6.
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7.
Rajitha Gunaratne Dylan N. Pratt Joseph Banda Daniel P. Fick Riaz J.K. Khan Brett W. Robertson 《The Journal of arthroplasty》2017,32(12):3854-3860
Background
Dissatisfaction following total knee arthroplasty (TKA) is common. Approximately 20% of patients report dissatisfaction following primary TKA. This systematic literature review explores key factors affecting patient dissatisfaction following TKA.Methods
Six literature databases published between 2005 and 1 January 2016 were searched using 3 key search phrases. Papers were included if the study investigated patient dissatisfaction in primary unilateral or bilateral TKA. Information from each article was categorized to the domains of socioeconomic, preoperative, intraoperative, and postoperative factors affecting patient dissatisfaction.Results
This review found that patient dissatisfaction pertains to several key factors. Patient expectations prior to surgery, the degree of improvement in knee function, and pain relief following surgery were commonly cited in the literature. Fewer associations were found in the socioeconomic and surgical domains.Conclusion
Identifying who may be dissatisfied after their TKA is mystifying; however, we note several strategies that target factors whereby an association exists. Further research is needed to better quantify dissatisfaction, so that the causal links underpinning dissatisfaction can be more fully appreciated and strategies employed to target them. 相似文献8.
Arpit C. Jariwala Avinash Parthasarathy Manish Kiran Linda R. Johnston David I. Rowley 《The Journal of arthroplasty》2017,32(7):2256-2261
Background
Numbness around the surgical scar can be a source of discomfort or dissatisfaction in a proportion of patients undergoing total knee arthroplasty (TKA). Literature reports wide variation in its prevalence and the consequence of numbness on the outcome of TKA is not clear. We investigated the prevalence of numbness, along with contributing factors, and assessed its effect on the functional outcome of TKA.Methods
In total, 258 knees were included in this prospective patient-reported outcome measure case-control study. Demographic details, type and length of incision, pre-operative and 1-year post-operative Knee Society Scores were recorded and compared.Results
The prevalence of numbness at 1 year was 53%, with a female preponderance. Patients older than 70 years were less affected. Discomfort due to numbness was recorded in 8.7% of the patients, 75% of which were female. The length of the incision correlated positively with the presence of numbness. The Knee Society Scores did not correlate with the presence or area of numbness.Conclusion
Our findings indicate a high prevalence of numbness after TKA. Nevertheless, numbness does not affect the functional outcome. 相似文献9.
Omar A. Behery Sean M. Kearns Justin M. Rabinowitz Brett R. Levine 《The Journal of arthroplasty》2017,32(5):1510-1515
Background
The ideal fixation for modern tibial components in total knee arthroplasty (TKA) remains controversial with uncertainty on whether cementless implants can yield equivalent outcomes to cemented fixation in early follow-up.Methods
A series of 70 consecutive cases with reverse hybrid cementless fixation were matched to 70 cemented cases from 2008 to 2015 based on implant design and patient demographics.Results
Cementless TKA demonstrated greater aseptic loosening (7 vs 0, P = .013) and revision surgery (10 vs 0, P = .001) than cemented fixation within 5 years of follow-up, but with no clinically significant differences in outcome scores.Conclusion
It remains unclear whether early aseptic loosening in cementless TKA can be reduced with enhanced adjunct fixation and what proportion of early failure justifies the potential lifelong fixation through biologic ingrowth of cementless tibial components. 相似文献10.
H. Park J.B. Park J.H. Kim K.W. Lee H.S. Lee G.-S. Kim D.-Y. Shin S.-H. Oh S.-M. Jin S.J. Kim 《Transplantation proceedings》2017,49(5):1142-1149
Background
In an experimental animal model of islet transplantation, stable induction of insulin-dependent diabetes mellitus (IDDM) and islet isolation from donor pancreas are essential. Total pancreatectomy for IDDM induction and islet procurement in nonhuman primates leads to unwanted loss of exocrine function and may lead to morbidities associated with IDDM.Methods
IDDM induction with streptozotocin (STZ) is associated with drug toxicity of STZ and necessitates the killing of another animal for islet procurement. In this study, we performed a subtotal pancreatectomy combined with reduced STZ injection to induce IDDM and procure islets in a nonhuman primate model.Results
Twelve cynomolgus monkeys received low-dose STZ injections (60 mg/kg) simultaneously with subtotal pancreatectomy. All monkeys recovered from the procedure without complications. IDDM was induced in the animals. 57,691 ± 16,050 islets were isolated from the resected pancreas and transplanted into other monkeys.Conclusions
Simultaneous subtotal pancreatectomy and low-dose STZ injection represent an effective and safe method to create an animal model of insulin dependence diabetes, while at the same time providing sufficient amounts of fresh islet cells for allotransplantation without requiring killing of additional animals. 相似文献11.
Kentaro Iwakiri Yoichi Ohta Akio Kobayashi Yukihide Minoda Hiroaki Nakamura 《The Journal of arthroplasty》2017,32(12):3637-3642
Background
The periarticular multimodal cocktail injection including morphine is currently commonly used to reduce postoperative pain following total knee arthroplasty (TKA). Despite its analgesic effect, it frequently causes nausea, which is an adverse effect of opioids. It is inconclusive whether the intraoperative injection of periarticular morphine is effective peripherally. The aim of this study was to assess whether the addition of morphine to unilateral periarticular knee injections improves postoperative pain, range of motion, and swelling in patients undergoing simultaneous bilateral TKA.Methods
A prospective, single-center, double-blinded, randomized, controlled trial was conducted to assess the local efficacy of adding morphine to intraoperative periarticular anesthesia in patients undergoing simultaneous bilateral TKA. Fifty-three patients undergoing 106 TKAs received an intraoperative periarticular injection in randomly selected one knee with added morphine (0.1 mg/kg) and the other knee without added morphine. The periarticular injection was composed of ropivacaine (a local anesthetic), epinephrine, ketoprofen, and methylprednisolone sodium. Visual analog scale pain scores at rest and on motion, range of motion (ROM), thigh swelling, the Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse outcomes were compared between the 2 knees.Results
There were no statistically significant differences in the visual analog scale score, ROM, thigh girth, Western Ontario and McMaster Universities Osteoarthritis Index score, and adverse events between the 2 sides.Conclusion
Adding morphine to periarticular injections is ineffective locally for relieving pain, reducing swelling, and improving the postoperative ROM. 相似文献12.
Hwa-Chang Liu Wen-Tien Wu Kai-Chiang Yang Kuang-Ting Yeh Shoichiro Sumi Chen-Chie Wang 《Journal of orthopaedic science》2017,22(3):506-511
Background
Rotational alignment of the distal femur is important in total knee arthroplasty. The purpose of this study is to use a roentgenographic technique to evaluate the accuracy of mini-incision total knee arthroplasty (MIS TKA) performed based on the transepicondylar line from the kneeling view.Methods
Totally 32 patients (aged from 64 to 80 years with an average of 70.9 years) with 46 cases of knee osteoarthritis received MIS TKA were registered. Before surgery, the condylar twist angle was measured from the kneeling view. The bone cut for the external rotation was completed, with regard to the condylar twist angle. The control group including 26 patients (aged from 50 to 89 years with an average of 69.7 years) with 42 cases of knee osteoarthritis underwent TKA with built-in cutting jig design 3 degrees of femoral external rotation. This study is a prospective continuous-time duration analysis study. The level of evidence is IIc.Results
The mean condylar twist angle was 5.1° in the experimental group and 5.4° in the control group. The mean postoperative angle between the clinical epicondylar axis and the posterior condylar line of the femoral component was 0.46°. The same postoperative angle of the built-in external rotation in the control group was 2.7°. The condylar twist angle was significantly more accurate than the built-in design.Conclusion
Our result substantiates that the kneeling view is practicable and reproducible as the cutting reference for femoral external rotation. The accuracy of the kneeling view shows that the epicondylar axis can be used in smaller wound surgery, such as MIS TKA.Level of evidence
Level IIc. 相似文献13.
Carlos J. Lavernia Anneliese D. Heiner Jesus M. Villa Jose C. Alcerro Mark D. Rossi 《The Journal of arthroplasty》2017,32(1):6-10
Background
The purpose of this study was to determine the influence of preoperative glycemic control in diabetic patients undergoing a primary total hip or knee arthroplasty. We wanted to study patient-perceived outcomes in the medium term, the length of stay, hospital costs, and rate of short-term postoperative complications.Methods
One hundred twenty consecutive primary total joint arthroplasties (TJAs) performed in type 2 diabetic patients were stratified into 2 groups representing optimal and suboptimal preoperative glycemic control, based on serum levels of glycated hemoglobin (HbA1c), and those groups compared.Results
The mean follow-up time was 5.9 years (range, 2.1-10.7 years). Both groups demonstrated improvement in all patient-perceived outcome measures after TJA, with no significant difference detected in any change of a measure between the groups. No significant difference was detected in the length of stay, hospital costs, or rate of short-term postoperative complications between the groups.Conclusion
Preoperative glycemic control in type 2 diabetic patients undergoing TJA did not affect patient-perceived outcomes in the medium term. Optimal vs suboptimal glycemic control in these patients also had no effect on the length of stay, hospital costs, or rate of short-term postoperative complications. 相似文献14.
Minako Murata-Ooiwa Sachiyuki Tsukada Motohiro Wakui 《The Journal of arthroplasty》2017,32(10):3024-3028
Background
Although multimodal pain management including periarticular multidrug injection can provide excellent pain relief in the early postoperative period after total knee arthroplasty (TKA), rebounding pain remains an important challenge. A randomized, double-blind, placebo-controlled trial was performed to investigate the efficacy of adding intravenous acetaminophen to multimodal pain management for TKA.Methods
We enrolled 67 patients scheduled for unilateral TKA. Patients were randomly assigned to receive either 1000 mg of intravenous acetaminophen at 6-hour intervals or normal saline at the same intervals. All patients were treated with intraoperative periarticular multidrug injection and intravenous and oral nonsteroidal anti-inflammatory drugs. The primary outcome was the postoperative 100-mm visual analog pain scale at the time of administration of study drugs.Results
In the intention-to-treat analysis, the pain score was significantly better in the intravenous acetaminophen group than the placebo group at 17:00 one day after TKA (15.3 ± 17.0 mm vs 26.8 ± 19.0 mm; P = .013). There were no significant differences in terms of the rate of complications between groups.Conclusion
Even in the setting of multimodal pain management including periarticular multidrug injection, intravenous acetaminophen provided better pain relief for patients undergoing unilateral TKA. 相似文献15.
Teng Lijia Zeng Rui-Xi Gong Long Chen Lei Liu Yujie He Jin-Yun Wang Zhen-Hu 《Journal of orthopaedic science》2017,22(5):880-885
Background
The interaction between patients is rather important source of information about surgery and recovery. Patients always prefer particularly to compare themselves with others of relatively similar ability, opinion and situation. Exploration of patients' dyads, however, is rare and needs further elaboration as to the significance of fellow patients. This study was designed to determine in whether and how preoperative assignment affects TKA's results.Methods
We assessed early post-operative outcomes in a cohort of 520 TKA patients. Preoperative, and postoperative outcome measures at 6-months following TKA were analyzed and compared between patients who were hospitalized with a roommate whose surgical status was either similar (preoperative) or dissimilar (postoperative) and whose type of surgery was either similar (TKA) or dissimilar (THA). Mean scores, and postoperative change in scores were calculated. Outcome measures evaluated included WOMAC, SF-36, patient affiliation, preoperative anxiety, expectation and analgesic consumption, length of hospital stay.Results
patients were more willing to have serious conversations with roommates whose surgical status was dissimilar (postoperative) and whose type of surgery was similar (TKA). And their SF-36 and WOMAC scores to be significantly improved better. Besides, they were released from hospital more quickly and showed significantly less preoperative anxiety.Conclusions
We recommend implementation of an assignment policy that patients prior to TKA should be assigned into a postoperative roommate undergoing TKA as well. 相似文献16.
Background
Total knee arthroplasty (TKA) is a highly successful surgery shown to improve quality of life. One of the more common known complications of TKA is early arthrofibrosis requiring manipulation under anesthesia (MUA). This investigation evaluates the incidence of arthrofibrosis before and after the implementation of an electronic sensor device used to assist with ligament balancing.Methods
Six hundred ninety TKAs performed without sensor use were compared to a cohort of 252 TKAs performed with sensor usage.Results
Prior to usage, there was a 5% rate of MUA after TKA, while after implementation, the MUA rate went down to 1.6% (P = .004). Ligament balancing using sensor assistance led to a statistically significant decrease in MUA in this cohort of patients. An odds ratio analysis also demonstrated that non-sensor patients had a 3.2× higher likelihood of requiring MUA than the sensor patients.Conclusion
The use of an electronic sensor device during trialing of TKA with resultant improved ligamentous balancing led to a statistically significant reduction in the rate of MUA in this cohort of patients. This type of approach to ligamentous balancing may continue to show evidence of improved clinical outcomes. 相似文献17.
Hidenori Tanikawa Mitsunori Tada Kengo Harato Kazunari Okuma Takeo Nagura 《The Journal of arthroplasty》2017,32(1):280-285
Background
Patellofemoral complications are one of the main problems after total knee arthroplasty (TKA). The design of the TKA component may affect the patellar biomechanics, which may be associated with this postoperative complication. The purpose of this study was to assess the influence of TKA and prosthesis designs on the patellar kinematics and patellofemoral pressure.Methods
Using fresh-frozen cadavers, we measured the patellofemoral pressure, patella offset, and patella tilt in the following 4 conditions: normal knee (patella replacement only), cruciate-retaining TKA, condylar-stabilizing TKA, and posterior-stabilized TKA.Results
The patellofemoral pressure increased significantly after the cruciate-retaining TKA and condylar-stabilizing TKA compared with the normal knee. The patella offset in the normal knee decreased with increasing knee flexion angles, while the patella offset in the TKA knees did not change significantly through the full range of motion. The amount of lateral patella tilt in the normal knee was significantly larger than the TKA knees in the full range of motion.Conclusion
Although the femoral components are designed to reproduce an anatomical patellar tracking, the physiological patellar kinematics were not observed. Relatively high patellofemoral pressure and kinematic change after TKA may be associated with postoperative complications such as the anterior knee pain. 相似文献18.
Cameron K. Ledford Brian P. Chalmers Joseph M. Statz Kevin I. Perry Tad M. Mabry Arlen D. Hanssen Matthew P. Abdel 《The Journal of arthroplasty》2017,32(1):101-105
Background
Clinical outcomes remain largely unknown beyond perioperative and short-term follow-up of solid organ transplant (SOT) patients undergoing total knee arthroplasty (TKA).Methods
Patient mortality, implant survivorship, and complications of 96 TKAs (76 patients) after SOT were retrospectively reviewed through an internal joint registry. Mean age at index arthroplasty was 66 years, and mean follow-up was 4 years.Results
Overall mortality rates at 1 year, 2 years, and 5 years from TKA were 2.6%, 7.9%, and 13.2%, respectively, and combined SOT patient survivorship was 92% at 2 years and 82% at 5 years. Implant survivorship free of any component revision or implant removal was 98% at 2 years and 93% at 5 years. There was a high rate of perioperative complications (12.5%), including periprosthetic fractures (5.2%) and deep periprosthetic infection (3.2%).Conclusion
TKA does not appear to have any effect on SOT patient survivorship following the procedure. However, SOT patients may have a higher risk of perioperative complications and a lower implant survivorship than the general population of TKA patients at midterm follow-up. 相似文献19.
Jakub Sikora-Klak Bradley Zarling Christopher Bergum Jeffrey C. Flynn David C. Markel 《The Journal of arthroplasty》2017,32(5):1414-1417
Background
As the annual demand and number of total joint arthroplasty cases increase, so do concerns of outcomes of patient with specific comorbidities relative to outcomes and costs of care.Methods
The study cohort included 2009 primary total knee arthroplasty (TKA) patients and 905 total hip arthroplasty patients. Discharge disposition was classified as discharge to any facility or home. The comorbidities of the patients who were readmitted and those without a 90-day event were also evaluated.Results
In the TKA population, age, female gender, nonsmoking status, venous thromboembolism (VTE) history, and diabetes were significantly associated with discharge to extended care facility (ECF) on univariate analysis, unlike body mass index. With multivariate analyses, female gender, age, VTE history, and diabetes were associated with ECF placement, but smoking was not. In the total hip arthroplasty population, age, female gender, and nonsmoking status were significantly associated with discharge to ECF on univariate analysis, whereas body mass index, diabetes, and VTE history were not. On multivariate analyses, female gender and age were associated with ECF, but smoking was not. The only significant finding for the readmission data was an increased rate of readmission for TKA patients of older age.Conclusion
The potential of projecting patient discharge and readmission allows physicians to counsel patients and improve patient expectations. 相似文献20.
Steven D. Culler David S. Jevsevar Kevin J. McGuire Kevin G. Shea Kenneth M. Little Michael J. Schlosser 《The Journal of arthroplasty》2017,32(6):1732-1738.e1