Background: Cardiovascular disease affects 121.5 million Americans, or 48% of the adult US population and is the leading cause of death in the United States. The demand for total joint replacement is expected to increase due to an aging population and advances in technology. Given the prevalence of cardiovascular disease and the expected increase in total joint replacement procedures, we sought to examine whether cardiovascular disease was associated with increased postoperative complications in patients undergoing total hip and knee replacements.Methods:CPT codes were used to investigate the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent total hip or knee replacements from 2010 to 2017. Patients were classified as having cardiovascular disease as per the American Health Association guidelines. Patient samples with all possible covariates were included in a multivariate logistic regression analysis. A patient sample size of 119,076 for total hip and 189,297 for total knee replacement was analyzed.Results: Patients with cardiovascular disease were found to have a statistically significant increased risk for the following postoperative complications: sepsis, wound complications, pneumonia, urinary tract infection, myocardial infarction, unplanned intubation, and cardiac arrest. Conclusions: Patients with cardiovascular disease undergoing a total hip or knee replacement have increased risk for wound, infectious and cardiovascular-associated postoperative complications. This finding necessitates the need for more frequent and sooner postoperative visits, a stringent cardiovascular preoperative evaluation, and patient education on the increased postoperative risks of joint replacements to lower the incidence of complications.
Objectives: Pediatric sport participation continues to increase in the United States with a corresponding increase in sports related concussions or traumatic brain injuries (TBIs). Based on this impact, it is important to recognize which sports are at elevated risk, identify patient and hospital-associated risk factors for hospital admission and length of stay, as well as understand billing costs for both individual and team sport participants. Improved awareness may help avoid disproportionate treatments, reduce economic burdens, and allow physicians to more effectively manage these injuries. Methods: Pediatric patients (ages 5-18) from 2008 to 2014 were identified from the Healthcare Cost and Utilization Project (HCUP) National (Nationwide) Inpatient Sample (NIS). ICD-9 CM codes were used to include 894 patients who were hospitalized with a concussion resulting from either participating in an individual (N = 451) or team sport (N = 443) (Figure 1). An adjusted odds ratio was calculated using demographic and hospital information. Welch ANOVA was performed to evaluate differences in length of hospital stay and total charges between cohorts. This was repeated for a loss of consciousness subgroup analysis within each cohort. Results: Younger athletes in individual sports were more likely to have associated loss of consciousness, be self-pay, experience a greater number of procedures, and require an operating room procedure. (Table 1). When compared to team sports, TBI patients in individual sports had significantly longer (p < 0.001) and costlier (p < 0.001) hospital stays (Table 2). The only significant finding that was worse in team sports was that loss of consciousness led to greater total charges (p < 0.001) (Table 2). For team sports, American tackle football, (43.6%) and for individual sports, bike riding, (28.2%) were the most frequent sports associated with TBIs in their respective cohorts (Table 3). Conclusions: Individual sport TBIs may be associated with longer and more expensive hospitalizations. The explanation is likely multifactorial but may be complicated by reduced awareness and reduced compliance with strict return to play protocols in individual sports. Safety education information at a young age, clear discharge instructions, and baseline health assessments when possible may help mitigate these findings.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.