Characterization of Re-admission and Emergency Department Visits Within 90 Days Following Lower-Extremity Arthroplasty

Background

Acute care events including emergency department (ED) visits and unscheduled inpatient re-admissions following lower-extremity arthroplasty are not fully understood.

Question/Purposes

The purpose of this study was to characterize acute care events occurring after discharge in patients who received a lower-extremity arthroplasty: the incidence, timing, and risk factors of inpatient admission and ED visits within 90 days of discharge.

Methods

The New York State Inpatient and Emergency Department Databases were used to identify patients who underwent elective total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2009 to 2013 (124,234 and 76,411 patients, respectively). Multivariate logistic regression analysis was used to determine the predictors of and the most frequent reasons for unscheduled acute care within 90 days of discharge.

Results

Unscheduled acute care was needed in 13.79% of patients (8.81% of inpatient re-admissions and 4.98% of ED visits), most often in the first week after discharge (61.05% of all inpatient re-admissions and 20.46% of all ED visits). Most of these visits were for musculoskeletal pain, peri-prosthetic joint or wound infection, cardiac complications, blood transfusion, psychiatric events, mechanical complications, and deep vein thrombosis. Predictors for the need for acute care after TKA included African American and Hispanic race or ethnicity, Medicaid coverage, and neuraxial anesthesia. Predictors for the need for acute care after THA included older age (over 85 years), African American race, and Medicaid coverage.

Conclusion

We identified demographic and procedure-related variables associated with an increased risk of ED visits and inpatient re-admissions after TKA or THA. Understanding these variables will contribute to improved care quality.

     

Use of Topical Tranexamic Acid Reduces Direct and Indirect Blood Loss and Transfusion Rates in Revision Total Hip Arthroplasty

Background

In primary total hip arthroplasty (THA), evidence supports the use of tranexamic acid (TXA) as an effective strategy for reducing blood loss, but scant evidence supports its use in revision THA.

Questions/Purposes

We aimed to evaluate whether the use of topical TXA in revision THA is associated with less blood loss and lower transfusion rates and to assess its safety, specifically as it relates to thromboembolic complications.

Methods

In this retrospective comparative study, two groups who underwent revision THA between 2005 and 2017 were defined: 98 patients who received 3 g of topical TXA (study group) and 475 patients who did not receive TXA (control group). Subjects were divided into subgroups according to the type of revision. Hemoglobin and hematocrit levels, blood loss, and transfusions were recorded. The follow-up period was 6 weeks.

Results

Median estimated blood loss, hidden blood loss, hemoglobin drop, and transfusion rates were significantly lower in the study group. The rates of post-operative thromboembolism were similar in the two groups. According to subgroup analysis, patients with revision of the femoral component, both components, and staged exchange revisions showed significantly lower rates of transfusion.

Conclusion

Topical TXA administration during revision THA effectively reduced direct and indirect blood loss, including hidden losses, without increasing the rates of thromboembolic events. This effect appeared to be enhanced when the femoral component was revised.