Does the Timing of the Second Surgery of a Staged Bilateral Total Joint Arthroplasty Affect the Rate of Hospital Adverse Events and Perioperative Outcomes? |
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| Institution: | 1. Levitetz Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL;2. Miami Orthopedics & Sports Medicine Institute, Baptist Health South Florida, Miami, FL;1. Department of Paediatric Allergy, School of Life Course Sciences, King''s College London, London, United Kingdom;2. Paediatric Allergy, Guy''s and St Thomas'' Hospitals NHS Foundation Trust, London, United Kingdom;3. Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom;1. SUNY Downstate College of Medicine, Brooklyn, NY, USA;2. Department of Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA;1. Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN;2. Department of Physical Therapy, University of Tennessee Health Science Center, Memphis, TN;3. Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC;4. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL;5. Department of Biomedical Engineering, University of Tennessee Health Science Center, Memphis, TN |
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| Abstract: | BackgroundThe optimal timing of the second surgery in primary staged bilateral total hip/knee arthroplasty remains uncertain. Perioperative hospital adverse events represent a significant issue, even “minor events” lead to substantial costs in workup tests, interconsultations, and/or increased hospital length-of-stay (LOS). Therefore, we sought to ascertain whether the timing of the second arthroplasty affects perioperative outcomes and/or rates of adverse events.MethodsWe retrospectively reviewed a consecutive series of 670 primary staged bilateral total hip/knee arthroplasty performed by 2 surgeons (2010-2016) at a single institution. The days between both arthroplasties were calculated for each pair of hips or knees. We evaluated demographics and LOS, discharge disposition, adverse events (ie, nausea, pulmonary embolism), and transfusion rates. The second arthroplasties (n = 335) were set apart in 2 groups based on the time they were done with respect to their corresponding contralateral first arthroplasty using 3 different thresholds: (1) ≤90 vs >90 days, (2) ≤180 vs >180 days, and (3) ≤365 vs >365 days.ResultsNo significant differences in outcome comparisons were observed using either 90 or 180 days thresholds. However, using the 365 days thresholds, the mean LOS (2.21 vs 1.92 days, P = .015), adverse event (26% vs 15.3%, P = .021), total transfusion (7.4% vs 1.5%, P = .020), and allogeneic transfusion (6.9% vs 1.5%, P = .033) rates were significantly higher in second arthroplasties performed at or less than 1 year apart from the first, respectively.ConclusionStaging the second arthroplasty more than a year apart from the first one seems to offer better LOS and rates of hospital adverse events, transfusions. However, unless patients are willing to wait a year between surgeries, our data also suggest no increased risk in regards to adverse events when proceeding before or after 90/180 days.Level of EvidenceLevel III. |
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| Keywords: | hospital adverse events perioperative outcomes staged bilateral total hip arthroplasty total knee arthroplasty |
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