Are Postoperative Complications More Common with Single-Stage Bilateral (SBTKR) Than with Unilateral Knee Arthroplasty: Guidelines for Patients Scheduled for SBTKR

Urban, Mi­chael; Chisholm, Mary F.; Wukovits, Barbara

doi:10.1007/s11420-005-0125-z

Cited by 53 publications

(48 citation statements)

References 17 publications

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“…The mean age of the patients was 65 years in the study by Urban et al (11). In the present study, 51.6% of the patients were aged below 65 years and 48.4% were above 65 years, a finding similar to that reported in the aforementioned studies.…”

Section: Discussionsupporting

confidence: 91%

The effects of systemic disorders on postoperative complications after simultaneous bilateral total knee replacement

Kandemir¹,

Muslu²,

Kalaycı³

et al. 2014

Turk J Anesth Reanim

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Amaç: Bu çalışmadaki amacımız retrospektif olarak kombine spinal epidural anestezi altında eşzamanlı bilateral total diz artroplastisi yapılan hastaların erken postoperatif dönemde gelişen major komplikasyonları ve bu komplikasyonların eşlik eden sistemik hastalıklarla ilişkisini incelemektir.Yöntemler: Retrospektif olarak 456 hasta incelendi. Hastaların preoperatif değerlendirmedeki ASA fiziksel sınıflaması değerleri, koroner arter hastalığı (KAH), kronik akciger hastalığı, diabetes mellitus (DM), hipertansiyon ve böbrek yetmezliği verileri kaydedildi. Ameliyat sonrası ilk bir hafta içinde gelişmiş kardiyovasküler ve solunum komplikasyonları, akut miyokard infarktüsü (AMI), tromboemboli, serebrovasküler olay (SVO), konfüzyon, akut böb-rek yetmezliği, şok ve kardiyopulmoner arrest gibi major komplikasyon verileri kaydedildi. Bulgular:Hastalarda DM ve hipertansiyon; DM, hipertansiyon ve KAH; DM ve KAH birlikteliklerinde komplikasyon görülme oranının istatiksel olarak anlamlı bir şekilde arttığını saptadık. İlk bir hafta içerisinde hastaların %0,2'sinde AMI, %3,3'ünde kardiyovasküler komplikasyon, %2,2'sinde solunum sistemi komplikasyonu, %0,9'unda tromboemboli, %0,2'sinde SVO, %2'sinde konfüzyon, %0,4'ünde arrest ve şok ve %2,2'sinde akut böbrek yetmezliği geliştiğini tespit etdik. Ayrıca 65 yaş üstü hastalarda kalp ve solunum sistemi komplikasyonları ve konfüzyon görülme oranı 65 yaş altı hastalara göre istatiksel olarak anlamlı yüksek olduğunu saptadık.Sonuç: Eşzamanlı bilateral total diz artroplastisi uygulanan hastalarda görülen erken dönem kalp, pulmoner komplikasyon ve konfüzyon daha çok 65 yaş üstü yaşlı hastalarda ve beraberinde diabetes mellitus ve kardiyovasküler komorbiditesi olanlarda yük-sek olduğunu bulduk.Anahtar Kelimeler: Diz replasmanı, rejyonal anestezik, postoperatif komplikasyonlar, komorbiditeObjective: The aim of the present study was to retrospectively evaluate the association between accompanying systemic disorders and major complications developing in the early postoperative period in patients who underwent simultaneous bilateral total knee arthroplasty with combined spinal and epidural anaesthesia. Methods:In the present study, the medical records of a total of 456 patients were analyzed. Preoperative data, including the American Society of Anesthesiologists physical status and presence of coronary artery disease (CAD), chronic pulmonary disease, diabetes mellitus (DM), hypertension and renal insufficiency were recorded. Furthermore, the data related to major complications, such as cardiac complications, respiratory complications, acute myocardial infarction (AMI), thromboembolism, cerebrovascular accident (CVA), confusion, acute renal failure (ARF), shock and cardiopulmonary arrest were recorded. Results:We found that the frequency of complications markedly increased in the presence of concurrent DM and hypertension, or DM, hypertension and CAD, or DM and CAD. Further, 0.2% of the patients developed AMI, 3.3% developed cardiac complications, 2.2% developed respiratory complications, 0....

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Section: Discussionsupporting

confidence: 91%

The effects of systemic disorders on postoperative complications after simultaneous bilateral total knee replacement

Kandemir¹,

Muslu²,

Kalaycı³

et al. 2014

Turk J Anesth Reanim

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“…28 In addition, 1 study of in-hospital mortality found that 0.5% of patients who had BTKA died compared with 0.3% of patients who had UTKA. 29 In contrast, our study identified lower mortality among patients who had UTKA, with no significant difference between cohorts (0.3% in the BTKA group v. 0.1% in the UTKA group, p = 0.48). Although the literature predominantly reflects higher mortality in patients who had BTKA, many BTKA = bilateral total knee arthroplasty; CI = con dence interval; COPD = chronic obstructive pulmonary disease; Hb = hemoglobin; OR = odds ratio; SD = standard deviation; UTKA= unilateral total knee arthroplasty.…”

Section: Recherchecontrasting

confidence: 84%

Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital

Spicer

Thomas

Rumble³

2013

Can J Surg

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Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital Background: Total knee arthroplasty (TKA) is a common surgical treatment for arthritis. In the event of bilateral knee symptoms, a patient may elect for bilateral TKA (BTKA) under 1 anesthetic or 2 separate unilateral TKAs (UTKA). Controversy exists in the literature regarding the safety of BTKA versus UTKA. We compared the rate of major intraoperative and postoperative complications for BTKA versus UTKA at a high-volume community hospital. Methods:We compared 373 patients who underwent BTKA with 966 who underwent UTKA between May 2008 and May 2011. Health records were used to determine patient characteristics and major intraoperative and postoperative complications. The BTKA and UTKA cohorts were matched for demographic characteristics and comorbidities with the exception of previous transient ischemic attack and previous knee surgery (UTKA > BTKA). Results:Rates of intraoperative and postoperative complications, including cardiovascular, thromboembolic and neurologic complications; deep wound infections; and mortality, did not differ significantly between groups. Bilateral TKA was associated with a greater proportion of patients requiring blood transfusion than UTKA (29.8% v. 8.9%, p < 0.001). Among those transfused, there was no significant difference between the groups in the mean number of units required (1.72 ± 0.77 v. 1.53 ± 0.85 units, p = 0.68). Conclusion:Bilateral TKA was not associated with statistically greater rates of intraoperative and postoperative complications than UTKA, barring the proportion of patients requiring transfusion. Our results support the use of BTKA to treat bilateral knee arthritis in a high-volume community hospital setting.Contexte : La prothèse (ou arthroplastie) totale du genou (PTG) est un traitement chirurgical courant contre l'arthrite. Quand les 2 genoux sont atteints, le patient peut choisir entre une PTG bilatérale (PTGB), qui ne nécessitera qu'une seule anesthésie, ou 2 interventions unilatérales distinctes (PTGU). Dans la littérature, on ne semble pas s'entendre sur l'innocuité de la PTGB contre la PTGU. Nous avons comparé les taux de complications peropératoires et postopératoires majeures associées aux PTGB et aux PTGU dans un hôpital communautaire où s'effectue un volume élevé de telles interventions. Résultats : Les taux de complications peropératoires et postopératoires, y compris cardiovasculaires, thromboemboliques et neurologiques, les infections de plaies profondes et la mortalité n'ont pas varié significativement entre les groupes. Une proportion plus grande de patients soumis à la PTGB a nécessité une transfusion sanguine comparativement aux patients soumis à la PTGU (29,8 % c. 8,9 %, p < 0,001). Parmi les receveurs de transfusions, on n'a noté aucune différence significative entre les groupes quant au nombre moyen d'unités requises (1,72 ± 0,77 c. 1,53 ± 0,85 unité, p = 0,68). Méthodes

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“…However, despite potential advantages of the same-day approach, including exposure to the risks of anesthetic only once, one postoperative course of pain, reduced rehabilitation, and an earlier return to baseline function [10,11,23], the safety of same-day procedures has been questioned because of higher morbidity and mortality when compared with unilateral TKAs [15,22]. Several studies have attempted to compare the incidence of complications after same-day bilateral TKAs, staged bilateral TKAs, and unilateral TKAs using single institution databases, large administrative datasets, or meta-analyses [1,6,7,9,14,15,18,22,[26][27][28]. However, there are no randomized trials comparing the safety of these surgical strategies.…”

Section: Introductionmentioning

confidence: 99%

“…However, there are no randomized trials comparing the safety of these surgical strategies. Because of the diversity of study settings and designs, it is difficult to draw definitive conclusions [1,6,7,9,14,15,18,22,[26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

Poultsides

Memtsoudis

Valle

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified. Questions/purposes We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than 3 months apart (staged 3-12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities. Methods We analyzed institutional data from 3960 sameday, 172 staged 0-3, and 1533 staged 3-12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Sameday patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality. Results There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group. Conclusions In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that sameday bilateral TKAs appeared to be safe.

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Are Postoperative Complications More Common with Single-Stage Bilateral (SBTKR) Than with Unilateral Knee Arthroplasty: Guidelines for Patients Scheduled for SBTKR

Abstract: A significant number of patients with degener-

Cited by 53 publications

References 17 publications

The effects of systemic disorders on postoperative complications after simultaneous bilateral total knee replacement

The effects of systemic disorders on postoperative complications after simultaneous bilateral total knee replacement

Comparison of the major intraoperative and postoperative complications between unilateral and sequential bilateral total knee arthroplasty in a high-volume community hospital

Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

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