Analysis of Risk Factors for High-Risk Patients Undergoing Total Joint Arthroplasty

Stock, Laura A; Brennan, Jane C; Dolle, Steffanie S.; Turcotte, Justin; King, Paul J.

doi:10.1016/j.artd.2022.02.031

Cited by 4 publications

(10 citation statements)

References 20 publications

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“…In patients undergoing total joint arthroplasty, both race and socioeconomic status have been identified as risk factors for worse patient outcomes [20][21][22][23]. Stock et al defined high-risk criteria as African American race, planned skilled nursing facility discharge, mental health or drug use issues, cardiac issues, or neurologic issues, and found those with one or more of these characteristics experienced longer lengths of stay and fewer home discharges [24]. Further, Weiner et al found female patients, non-Hispanic Black patients, obese patients, Medicaid or uninsured status, patients older than 75, Charlson comorbidity index over three, and hip fracture diagnosis to be associated with an increased risk of an increased length of stay longer than two days as well as a non-home discharge [25].…”

Section: Discussionmentioning

confidence: 99%

Disparities in Hand Surgery Exist in Unexpected Populations

Stock¹,

Brennan²,

Johnson³

et al. 2023

Cureus

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BackgroundThe purpose of our study is to investigate disparities in the patient populations and outcomes of carpal tunnel release (CTR) and trigger finger release (TFR). MethodsA retrospective review of 777 CTR and 395 TFR patients from May 2021 to August 2022 was completed. The shortened form of the Disabilities of the Arm, Shoulder, and Hand (DASH) scores (QuickDASH) was recorded to evaluate physical function preoperatively and at one and three months postoperatively. This study was deemed institutional review board-exempt by the institutional clinical research committee. ResultsCompared to CTR, TFR patients resided in zip codes with higher levels of social vulnerability across dimensions of 'household composition and disability' (p=0.018) and 'minority status and language' (p=0.043). When analyzing QuickDASH scores by demographics and procedure, preoperative scores were statistically significantly higher for non-married (p=0.002), White (p=0.003), and female sex (p=0.001) CTR patients. Further, one-month postoperative scores were statistically higher for White and non-married CTR patients (0.016 and 0.015, respectively). At three months postoperatively, female and non-married patients had statistically significant higher scores (0.010 and 0.037, respectively). In TFR patients, one-month postoperative QuickDASH scores for White and female patients were statistically significantly higher (0.018 and 0.007, respectively). There were no significant differences in QuickDASH scores between rural and nonrural patients, household income (HHI) above or below the median, or the Social Vulnerability Index (SVI) dimensions. ConclusionOur study found marital status, sex, and race were associated with disparities in pre-and postoperative physical function in patients undergoing carpal tunnel or trigger finger release. However, future studies are warranted to confirm and develop solutions to disparities within this population.

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Section: Discussionmentioning

confidence: 99%

Disparities in Hand Surgery Exist in Unexpected Populations

Stock¹,

Brennan²,

Johnson³

et al. 2023

Cureus

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“… 2) As the use of TKA expands, increased efforts have been made to identify risk factors associated with adverse outcomes. 3 4) Cardiovascular disease is the leading cause of global mortality and is identified as a significant risk factor for adverse outcomes in patients undergoing surgery. 3 4) Specifically for TKA, preexisting cardiac disease is noted as a risk factor for postoperative cardiac and thromboembolic events, and subsequently a higher risk of readmission and mortality.…”

mentioning

confidence: 99%

“… 3 4) Cardiovascular disease is the leading cause of global mortality and is identified as a significant risk factor for adverse outcomes in patients undergoing surgery. 3 4) Specifically for TKA, preexisting cardiac disease is noted as a risk factor for postoperative cardiac and thromboembolic events, and subsequently a higher risk of readmission and mortality. 4 5 6) Additionally, heart failure has been associated with an increased risk of prolonged length of stay (LOS), readmission, and postoperative complications following TKA.…”

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confidence: 99%

“… 4) Despite these findings, our understanding of the role of cardiovascular disease in TKA is limited. 3 4 5 6 7) The nomenclature used for the designation of a cardiac diagnosis is inconsistent in the literature, which may draw our understanding of its epidemiology into question. 3 4 5 6 7) At present, there are no studies that utilize multivariate analysis to assess the influence of other prevalent cardiac diseases such as coronary artery disease (CAD), valvular dysfunction, or arrhythmias on outcomes following TKA.…”

mentioning

confidence: 99%

“… 3 4 5 6 7) The nomenclature used for the designation of a cardiac diagnosis is inconsistent in the literature, which may draw our understanding of its epidemiology into question. 3 4 5 6 7) At present, there are no studies that utilize multivariate analysis to assess the influence of other prevalent cardiac diseases such as coronary artery disease (CAD), valvular dysfunction, or arrhythmias on outcomes following TKA. Understanding the impact of cardiac comorbidities on TKA outcomes is essential for the optimization of postoperative outcomes and reduction of complications.…”

mentioning

confidence: 99%

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Cardiovascular Disease in Total Knee Arthroplasty: An Analysis of Hospital Outcomes, Complications, and Mortality

Okpara,

Lee,

Pathare

et al. 2024

Clin Orthop Surg

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Background Cardiovascular comorbidities have been identified as a significant risk factor for adverse outcomes following surgery. The purpose of this study was to investigate its prevalence and impact on postoperative outcomes, hospital metrics, and mortality in patients undergoing total knee arthroplasty (TKA). Our hypothesis was that patients with cardiovascular comorbidities would have worse outcomes, greater postoperative complication rates, and increased mortality compared to patients without cardiovascular disease. Methods In this retrospective study, data from the National Inpatient Sample database from 2011 to 2020 were queried for patients who underwent TKA with preexisting cardiac comorbidities, including congestive heart failure (CHF), coronary artery disease (CAD), valvular dysfunction, and arrhythmia. Multivariate logistic regression analyses compared hospital metrics (length of stay, costs, and adverse discharge disposition), postoperative complications, and mortality rates while adjusting for demographic and clinical variables. All statistical analyses were performed using R studio 4.2.2 and Stata MP 17 and 18 with Python package. Results A total of 385,585 patients were identified. Those with preexisting CHF, CAD, valvular dysfunction, or arrhythmias were found to be older and at higher risk of adverse outcomes, including prolonged length of stay, increased hospital charges, and increased mortality ( p < 0.001). Additionally, all preexisting cardiac diagnoses led to an increased risk of postoperative myocardial infarction, acute kidney injury (AKI), and need for transfusion ( p < 0.001). The presence of valvular dysfunction, arrhythmia, or CHF was associated with an increased risk of thromboembolic events ( p < 0.001). The presence of CAD and valvular dysfunction was associated with an increased risk of urologic infection ( p < 0.001). Conclusions This study demonstrated that CHF, CAD, valvular dysfunction, and arrhythmia are prevalent among TKA patients and associated with worse hospital metrics, higher risk of perioperative complications, and increased mortality. As our use of TKA rises, a lower threshold for preoperative cardiology referral in older individuals and early preoperative counseling/intervention in those with known cardiac disease may be necessary to reduce adverse outcomes.

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