Abstract Recently, the government has moved towards public reporting of 30-day readmission rates after elective primary total knee (TKA) and total hip arthroplasty (THA). We identified 11,814 and ...8105 patients who underwent primary TKA and THA from the 2011 ACS NSQIP. Overall readmission rates within 30-days of surgery were 4.6% for TKA and 4.2% for THA. Complications associated with readmission were predominantly wound infections, sepsis, thromboembolic, cardiac, and respiratory related. In TKA, multivariate analysis identified age ( P = 0.002), male gender ( P = 0.03), cancer history ( P = 0.008), elevated BUN ( P = 0.002), a bleeding disorder ( P < 0.001) and high ASA class ( P < 0.001) as predictors of readmission. In THA, obesity ( P = 0.008), steroid use ( P = 0.037), a bleeding disorder ( P = 0.002), dependent functional status ( P = 0.022), and high ASA class ( P < 0.001) predicted readmission. Understanding characteristics associated with readmission will be essential for equitable patient risk stratification.
Total joint arthroplasty is the most frequently performed orthopaedic procedure in the United States. The purpose of the present study was to identify differences in thirty-day morbidity and ...mortality following primary total hip and total knee arthroplasty according to smoking status and pack-year history of smoking.
We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to identify patients who had undergone primary total hip or total knee arthroplasty between 2006 and 2012. Patients were stratified by smoking status and pack-year history of smoking. Thirty-day rates of mortality, wound complications, and total complications were compared with use of univariate and multivariate analyses.
We identified 78,191 patients who had undergone primary total hip or total knee arthroplasty. Of these, 81.8% (63,971) were nonsmokers, 7.9% (6158) were former smokers, and 10.3% (8062) were current smokers. Current smokers had a higher rate of wound complications (1.8%) compared with former smokers and nonsmokers (1.3% and 1.1%, respectively; p < 0.001). Former smokers had a higher rate of total complications (6.9%) compared with current smokers and nonsmokers (5.9% and 5.4%, respectively; p < 0.001). Multivariate analysis identified current smokers as being at increased risk of wound complications (odds ratio OR, 1.47; 95% confidence interval CI, 1.21 to 1.78), particularly deep wound infection, while both current smokers (OR, 1.18; 95% CI, 1.06 to 1.31) and former smokers (OR, 1.20; 95% CI, 1.08 to 1.34) were at increased total complication risk. Increasing pack-year history of smoking resulted in increasing total complication risk.
On the basis of our findings, current smokers have an increased risk of wound complications and both current and former smokers have an increased total complication risk following total hip or total knee arthroplasty.
Abstract The authors assessed the incidence of and risk factors associated with 30-day surgical site infections (SSIs) following primary (p) and revision (r) THA and TKA. In total, 23,128 primary and ...2170 revision TJAs were identified between 2005 and 2010 in the ACS NSQIP database. The 30-day SSI rates, overall and deep, were 1.1 and 0.1% for pTKA, 1.18 and 0.4% for pTHA, 1.68 and 0.7% for rTKA, and 2.9 and 1.7% for rTHA. After primary TJA, independent risk factors were BMI > 40, hypertension, prolonged operative time, electrolyte disturbance and previous infection, and after revision TJA, dyspnea and bleeding disorder were risk factors. This study should help provide benchmark data for SSI following TJA.
Abstract Background Increased operative time has been associated with increased complications following TJA. The purpose of the present study was to investigate the effect of operative time on ...short-term complications following TJA while also identifying patient and operative factors associated with prolonged operative times. Methods The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2011-2013 to identify all patients who underwent primary total hip or knee arthroplasty. Patients were stratified by operative time, and 30-day morbidity and mortality data compared using univariate and multivariable analyses. Results We identified 99,444 patients who underwent primary TJA. The overall incidence of complications following TJA was 4.9%. Overall complications were increased in patients with operative times >120 minutes (5.9%) as compared to patients with operative times <60 minutes or 60-120 minutes (4.6% and 4.8%, respectively; p<0.001). Wound complications, including surgical site infection, were also increased for procedures lasting >120 minutes. In a multivariable analysis, operative time exceeding 120 minutes remained an independent predictor of any complication and wound complication, with each 30-minute increase in operative time beyond 120 minutes further increasing risk. Patient age ≤65 years, male sex, black race, BMI ≥ 30 kg/m2 , and an ASA classification of 3 or 4 all predicted operative times >120 minutes. Conclusions We found that operative time >120 minutes was associated with increased short-term morbidity and mortality following primary TJA. Younger age, male sex, black race, obesity, and increased comorbidity were risk factors for operative time exceeding 120 minutes.
Abstract The efficacy of the anterior, relative to other operative approaches, in promoting earlier return to function after hip arthroplasty has not been well established. We retrospectively ...compared 41 anterior and 47 posterior approach cases. Mean hospital stay (2.9 vs. 4 days, p = 0.001) and days to mobilization (2.4 vs. 3.2 days, p = 0.006) were shorter with the anterior approach. After multivariate regression, the anterior approach remained a significant predictor of early discharge ( p = 0.009). Lateral femoral cutaneous nerve neuropraxia (17%) and fracture (2%), were more common in the anterior cohort, but all patients recovered without sequela. Overall, the anterior approach patients had earlier discharge and mobilization as compared to patients who received the posterior approach. Neuropraxia and fracture remain a concern, but the clinical significance was low in our cohort.
Background Few studies have reported incidence of or risk factors for morbidity and mortality after elective shoulder arthroscopy. Methods We used Current Procedural Terminology (CPT) billing codes ...to query the National Surgical Quality Improvement Program database and identified 9410 cases of elective shoulder arthroscopy. Univariate and multivariate analyses were used to identify risk factors for complication. Results Among 9410 patients, 109 complications occurred in 93 (0.99%). Major morbidity was 0.54% (51 patients), which included 4 patients (0.04%) with a mortality, and minor morbidity was 0.44% (42 patients). The most common complication was a return to the operating room (29 cases, 0.31%). Superficial surgical site infections occurred in 15 cases (0.16%), deep infections in 1 (0.01%), deep venous thrombosis or thrombophlebitis in 8 (0.09%), peripheral nerve injury in 1 (0.01%), and pulmonary embolism in 6 (0.06%). The multivariate analysis showed smoking history (odds ratio OR, 1.91; 95% confidence interval CI, 1.12-3.27), history of chronic obstructive pulmonary disease (OR, 3.25; 94% CI, 1.38-7.66), operative time of longer than 1.5 hours (OR, 2.1; 95% CI, 1.32-3.36), and American Society of Anesthesia class of 3 or 4 compared with 1 or 2 (OR, 1.82; 95% CI, 1.03-3.21) as risk factors for complication. Conclusions Morbidity and mortality are rare events after elective shoulder arthroscopy, and the procedure should generally be considered safe. Surgeons should offer smoking cessation to active users of tobacco and should be efficient with operative time whenever possible.
The Centers for Medicare & Medicaid Services targeted thirty-day readmissions as a quality-of-care measure. Hospitals can be penalized on unplanned readmissions. Given the frequency of amputation in ...diabetic patients and our changing health-care system, the purpose of this study was to determine the incidence, risk factors, and causes for unplanned thirty-day readmissions following primary lower-extremity amputation in diabetic patients.
Patients with a diagnosis of diabetes undergoing primary lower-extremity amputation between 2002 and 2013 were retrospectively identified in a single-center patient database. Chart review determined patient factors including comorbidities, hemoglobin A1c level, amputation level, and demographic characteristics. Patients were divided into groups with and without unplanned readmission within thirty days postoperatively. Univariate and multivariate logistic regression analyses were used to compare cohorts and to identify variables associated with readmission.
Overall, forty-six (10.5%) of 439 diabetic patients undergoing primary lower-extremity amputation had an unplanned thirty-day readmission. The top reason for readmission was a major surgical event requiring reoperation (37.0%), followed by medical events (28.3%) and minor surgical events (28.3%). In the univariate analysis, discharge on antibiotics (p = 0.002), smoking (p = 0.003), chronic kidney disease (p = 0.002), peripheral vascular disease (p = 0.002), and higher Charlson Comorbidity Index (p = 0.001) were each associated with readmission. In the multivariate analysis, diagnosis of gangrene (odds ratio OR, 2.95 95% confidence interval (95% CI), 1.37 to 6.35), discharge on antibiotics (OR, 4.48 95% CI, 1.71 to 11.74), smoking (OR, 3.22 95% CI, 1.40 to 7.36), chronic kidney disease (OR, 2.82 95% CI, 1.30 to 6.15), and peripheral vascular disease (OR, 2.47 95% CI, 1.08 to 5.67) were independently associated with readmission.
Thirty-day readmission rates following primary lower-extremity amputation in patients with diabetes were high at >10%. Both medical and surgical complications, many of which were unavoidable, contributed to readmission. Quality-reporting metrics should include these risk factors to avoid undeservedly penalizing surgeons and hospitals caring for this patient population.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Abstract Background When new technologies are introduced, it is important to evaluate the rate of adoption and outcomes compared with preexisting technology. The purpose of this study was to ...determine the adoption rate of computer-assisted navigation in total knee arthroplasty (TKA), to determine if the short-term complication rate changed over time with navigation, and to compare short-term complication rates of navigated and traditional TKA. Methods The American College of Surgeons National Surgical Quality Improvement Program database was used to identify 108,277 patients undergoing primary TKA between 2010 and 2014, of which 3573 cases (3.30%) were navigated. Rates of adoption of navigated TKA were determined. Differences in short-term complications by year were compared using propensity score matching. Results Navigation utilization decreased from 4.96% in 2010 to 3.06% in 2014. Blood transfusion rates for the entire cohort decreased from 19% in 2011 to 6% in 2014, and was not decreased with navigation compared with traditional TKA in 2014 ( P = .1309). Operative time was not increased by navigation, and average 94.2 minutes. There were no significant differences in all-cause complications, reoperation rate, unplanned readmission, or length of stay for any year. Conclusions There was a 38.3% decrease in TKA navigation utilization from 2010-2014. Blood transfusion rates decreased 68% over the 5-year study, and were not decreased with navigation in 2014. Navigation was not found to increase operative time. There were no significant differences in short-term complications, readmission rate, or length of stay between navigated and traditional TKA.
Abstract 26-27% of patients with end stage hip and knee arthritis requiring TJR have chronic renal disease. A multi-center, prospective clinical registry was queried for TJA's from 2006 to 2012, and ...74,300 cases were analyzed. Renal impairment was quantified using estimated glomerular filtration rate (eGFR) to stratify each patient by stage of CRD (1–5). There was a significantly greater rate of overall complications in patients with moderate to severe CRD (6.1% vs. 7.6%, P < 0.001). In those with CRD (Stage 3–5), mortality was twice as high (0.26% vs. 0.48%, P < 0.001). Patients with Stage 4 and 5 CRD had a 213% increased risk of any complication (OR 2.13, 95% CI: 1.73–2.62). Surgeons may use these findings to discuss the risk–benefit ratio of elective TJR in patients with CRD.
When Hip Scopes Fail, They Do So Quickly Bedard, Nicholas A., MD; Pugely, Andrew J., MD; Duchman, Kyle R., MD ...
The Journal of arthroplasty,
06/2016, Letnik:
31, Številka:
6
Journal Article
Recenzirano
Abstract Background Rates of hip arthroscopy have been on an exponential rise. The purpose of this study was to evaluate the rate and timing of subsequent total hip arthroplasty (THA) after hip ...arthroscopy and identify if rates of THA differed based on age, diagnosis of osteoarthritis, or arthroscopic procedure performed. Methods The Humana administrative claims data set was reviewed from 2007 to 2014 for all patients undergoing hip arthroscopy. Patients were identified using Current Procedural Terminology codes and laterality modifiers. Patients were tracked over time for the occurrence of an ipsilateral THA. Rates and timing of subsequent THA were then determined. Subgroup analysis was performed based on patient age and hip arthroscopy procedure performed. Results In total, 1577 patients underwent hip arthroscopy. Tracking of patients revealed 84 (5.3%) patients that had an ipsilateral THA after hip arthroscopy during the follow-up period. Of the subsequent THA, 35.7% occurred within 6 months of hip arthroscopy and 83.3% had occurred within 18 months. Hundred percent of subsequent THAs occurred within 48 months of initial hip arthroscopy. Patients aged ≥50 years at the time of hip arthroscopy had a higher odds of conversion to THA (odds ratio: 3.2 2.05-5.01, P < .001) as did those with chondroplasty included in their procedure (odds ratio: 3.5 2.10-5.84, P < .001). Conclusion Approximately 5% of hip arthroscopies went on to require a subsequent THA, and all conversions to THA occurred within 4 years. These data suggest that when hip arthroscopy fails, it does so relatively soon after the procedure. These results provide a needed understanding of rates and timing of THA after hip arthroscopy.
