Risk Factors for Early Hospital Readmission Following Total Knee Arthroplasty

Lehtonen, Eva; Hess, Matthew; McGwin, Gerald; Shah, Ashish; Godoy‐Santos, Alexandre Leme; Naranje, Sameer

doi:10.1590/1413-785220182605190790

Cited by 28 publications

(27 citation statements)

References 18 publications

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“…Four studies used data from a single hospital database [ 23 , 24 , 27 , 36 ], 1 study was a multicenter registry database [ 32 ], and the remaining 23 studies used nationwide databases [ 14 – 22 , 24 – 26 , 28 – 31 , 33 – 38 ] (Table 1 ). Eighteen studies did not include any comparator group, reporting solely on either pTKAs (16 studies) [ 15 , 17 – 19 , 21 , 22 , 25 – 28 , 30 , 31 , 33 – 35 , 38 ] or rTKAs (2 studies) [ 8 , 20 ]. The remaining 10 studies included various comparator cohorts (pTKAs vs. rTKAs in 7 studies [ 6 , 14 , 23 , 24 , 29 , 36 , 37 ], unilateral versus simultaneously bilateral TKAs in 2 studies [ 7 , 37 ], and unicompartmental versus pTKAs in 2 studies [ 16 , 32 ] (Table 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Data were obtained from 17 studies reporting on 7,808,247 patients [ 6 , 7 , 15 , 19 , 21 , 22 , 25 , 28 – 30 , 32 – 38 ]. The pooled estimate of effect size for SAE rate was 5.7% (95% CI 4.4−7.2%, I 2 = 100%).…”

Section: Resultsmentioning

confidence: 99%

“…Twenty risk factors for SAEs or 30d-RR were identified across primary studies based on multivariate analysis. The most frequently documented risk factors with a positive correlation to the outcome of interest in the primary studies were increased age (13 studies) [ 14 – 16 , 18 , 19 , 22 , 25 – 29 , 36 , 37 ], male gender (10 studies) [ 7 , 8 , 14 – 16 , 18 , 19 , 26 , 29 , 37 ], ASA scores 3−4 (8 studies) [ 8 , 15 , 19 , 20 , 22 , 25 , 26 , 28 ], and pulmonary disease (8 studies) [ 7 , 8 , 18 , 19 , 22 , 26 , 28 , 35 ]. Based on the GRADE analysis, 2 of the most frequently stated risk factors (age, ASA 3−4) had minimal bias, while another two (male gender, pulmonary disease) were obtained from studies of moderate quality.…”

Section: Resultsmentioning

confidence: 99%

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Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis

et al. 2021

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Background Elective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved. Methods To obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA with patient N > 1000, and the SAE or 30-dRR rate could be calculated. SAEs included return to operating room, death or coma, venous thromboembolism (VTE), deep infection or sepsis, myocardial infarction, heart failure or cardiac arrest, stroke or cerebrovascular accident, or pneumonia. Results Of 248 references reviewed, 28 are included, involving 10,153,503 patients; this includes 9,483,387 patients with primary TKA (pTKA), and 670,116 patients with revision TKA (rTKA). For pTKA, the SAE rate was 5.7% (95% CI 4.4−7.2%, I2 = 100%), and the 30-dRR was 4.8% (95% CI 4.3−5.4%, I2 = 100%). For rTKA, the SAE rate was 8.5% (95% CI 8.3−8.7%, I2 = 77%), while the 30-dRR was 7.2% (95% CI 6.4−8.0%, I2 = 81%). Odds of 30-dRR following pTKA were about half that of rTKA (OR 0.57, 95% CI 0.53−0.62%, p < 0.001, I2 = 45%). Of patients who received pTKA, the commonest SAEs were VTE (1.22%; 95% CI 0.83−1.70%) and genitourinary complications including renal insufficiency or renal failure (1.22%; 95% CI 0.83−1.67%). There has been significant improvement in SAE rate and 30-dRR since 2010 (χ2 test < 0.001). Conclusions TKA procedures have a relatively low complication rate, and there has been a significant improvement in SAE rate and 30-dRR over the past decade.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis

et al. 2021

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“…Cada ano acrescentado à idade aumenta a chance de reinternação e de mortalidade. 30 A obesidade é um fator claramente envolvido na gênese e na progressão da OA do joelho. 6 Esse fato foi comprovado na nossa amostra, em que apenas 16,9% dos pacientes foram normotróficos, sendo o restante com sobrepeso ou obesos.…”

Section: Resultsunclassified

Perfil epidemiológico e clínico dos pacientes submetidos a artroplastia total do joelho

Loures

Góes

Gusmão

et al. 2021

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Definir o perfil epidemiológico e as comorbidades associadas dos pacientes submetidos à artroplastia total do joelho (ATJ) em dois hospitais de referência. Materiais e Métodos Durante o estudo observacional transversal, foram avaliados 294 pacientes submetidos à ATJ em 2 hospitais de atenção terciária. Coletou-se, por entrevista direta, o diagnóstico das comorbidades auto-relatadas. Foram calculados o índice de comorbidades funcionais (do inglês Functional Comorbidity Index, FCI) e o índice modificado de cinco fatores de fragilidade (do inglês 5-Factor Modified Frailty Index, mFI-5). Avaliou-se a incidência das comorbidades e a relação destas com os índices calculados. Resultados A maioria dos pacientes da amostra foram mulheres (p = 0,000) entre a sétima e oitava décadas de vida. A hipertensão arterial sistêmica foi a patologia mais comum, seguida de obesidade e diabetes mellitus. O ICF apresentou uma relação direta com sexo feminino (p = 0,038) e a obesidade (p < 0,001). O mFI-5 apresentou relação somente com a obesidade (p = 0,022), e demonstrou uma chance maior de complicações nesse grupo. Conclusão Os pacientes submetidos à ATJ são essencialmente portadores de comorbidades clínicas que podem influenciar negativamente os resultados funcionais e comprometer a segurança do procedimento. A identificação dos fatores de risco pode contribuir para a segurança e melhor seleção dos candidatos a ATJ.

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“…For example, some studies used age as continuous variable [22,42], whereas others created bins for age as a categorical variable as per differing cutoff points [24e27,32]. Similarly, some studies presented ORs for 30-day readmission as an outcome [10,11,21,26,30,32,33,34,36], whereas others for 90-day readmission as an outcome [23e25, 35,43].…”

Section: Resultsmentioning

confidence: 99%

Risk Factors for Readmission After Knee Arthroplasty Based on Predictive Models: A Systematic Review

et al. 2020

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Background: An increase in the aging yet active US population will continue to make total knee arthroplasty (TKA) procedures routine in the coming decades. For such joint procedures, the Centers for Medicare and Medicaid Services introduced programs such as the Comprehensive Care for Joint Replacement to emphasize accountable and efficient transitions of care. Accordingly, many studies have proposed models using risk factors for predicting readmissions after the procedure. We performed a systematic review of TKA literature to identify such models and risk factors therein using a reliable appraisal tool for their quality assessment. Methods: Five databases were searched to identify studies that examined correlations between post-TKA readmission and risk factors using multivariate models. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology and Transparent Reporting of a multivariate prediction model for Individual Prognosis Or Diagnosis criteria established for quality assessment of prognostic studies. Results: Of 29 models in the final selection, 6 models reported performance using a C-statistic, ranging from 0.51 to 0.76, and 2 studies used a validation cohort for assessment. The average 30-day and 90-day readmission rates across the studies were 5.33% and 7.12%, respectively. Three new significant risk factors were discovered. Conclusions: Current models for TKA readmissions lack in performance measurement and reporting when assessed with established criteria. In addition to using new techniques for better performance, work is needed to build models that follow the systematic process of calibration, external validation, and reporting for pursuing their deployment in clinical settings.

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Risk Factors for Early Hospital Readmission Following Total Knee Arthroplasty

Cited by 28 publications

References 18 publications

Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis

Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: a systematic review and meta-analysis

Perfil epidemiológico e clínico dos pacientes submetidos a artroplastia total do joelho

Risk Factors for Readmission After Knee Arthroplasty Based on Predictive Models: A Systematic Review

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