Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients

Anoushiravani, Afshin A.; Sayeed, Zain; Chambers, Monique C.; Gilbert, Theodore J.; Scaife, Steven; El-Othmani, Mouhanad M.; Saleh, Khaled J.

doi:10.1016/j.arth.2015.12.053

Cited by 29 publications

(32 citation statements)

References 24 publications

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“…MI was assessed by 14 studies, CA in 7, and arrhythmia in only 2. Authors in one study [30] did not specify which cardiac complication they evaluated. Risk factors evaluated by the included studies included modifiable and non-modifiable patient factors, comorbidities, and surgery type (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…In 13 studies, TJA cohorts were predominated by the female gender (Table 2), whilst two studies did not provide gender-specific information of the total cohort in their primary text [5, 31]. The most common arthroplasty procedure in this series was TKA, with the exception of two studies [17, 30].…”

Section: Resultsmentioning

confidence: 99%

“…The most common arthroplasty procedure in this series was TKA, with the exception of two studies [17, 30].…”

Section: Resultsmentioning

confidence: 99%

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Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

et al. 2019

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BackgroundCardiac complication represents a major cause of morbidity and mortality after total joint arthroplasty, thus necessitating investigation into the associated risks in total hip arthroplasty and total knee arthroplasty. There remains a lack of clarity for many risk factors in the current literature. The aim of this systematic review is to assess the most recent published literature and identify the risk factors associated with cardiac complication in total hip arthroplasty and total knee arthroplasty.MethodsScopus, PubMed, CINHAL, and Cochrane were searched to identify studies published since 2008 reporting on risk factors associated with cardiac complication in elective primary in total hip arthroplasty and total knee arthroplasty in patients ≥18 years old with osteoarthritis. Reported odds ratios, hazard ratios, and relative risk were the principal summary measures collected. The included studies were too heterogeneous to enable meta-analysis.ResultsFifteen studies were included in this systematic review. Increasing age and history of cardiac disease were found by most studies to be positively associated with risk of cardiac complication. There was no strong association found between obesity and cardiac complication. The evidence for other risk factors was less clear in the examined literature, although there is suggestive evidence for male gender and cerebrovascular disease increasing risk.ConclusionsIncreasing age and history of cardiac disease increases the risk of cardiac complication after total hip arthroplasty and total knee arthroplasty. Other risk factors commonly attributed to increased risk in non-cardiac surgery including hypertension and obesity require further evaluation in arthroplasty.Systematic review registrationA detailed protocol was published in the PROSPERO database (registration number CRD42018095887) for this systematic review.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-1058-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

et al. 2019

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“…After duplicates were removed, 1557 articles were screened for eligibility with reasons for exclusion listed. A total of 9 articles published between 2011 to 2018, with 218,151 TKA patients, were included in this review [19][20][21][22][23][24][25][26][27]. Of those, 4 articles [22][23][24]27] met the criteria to undergo meta-analysis.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Intrinsic patient factors predictive of inpatient rehabilitation facility discharge following primary total knee arthroplasty: a systematic review and meta-analysis

Sattler

Hing

Rathbone

et al. 2020

BMC Musculoskelet Disord

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Background: Total Knee Arthroplasty (TKA) reduces pain and improves function in those suffering from severe osteoarthritis. A significant cost of TKA is post-acute care, however, current evidence suggests that discharge to an Inpatient Rehabilitation Facility (IRF) has inferior outcomes to home discharge, with no greater benefit in physical function. Only individual studies have investigated TKA patient characteristics predictive of discharge destination, therefore, the aim is to systematically review the literature and meta-analyse intrinsic patient factors predictive of IRF discharge. If predictive factors are known, then early discharge planning and intervention strategies could be implemented. Methods: Databases PubMed, CINAHL, Embase, Cochrane, and Pedro were searched up to October 2019 for all studies investigating pre-operative intrinsic patient factors predictive of IRF discharge. For assessing the methodological quality of included studies, the Quality In Prognosis Studies (QUIPS) tool was used. Statistical analysis and graphical reporting were conducted in R statistical software. To assess the effect of predictors of discharge destination, odds ratios with the corresponding 95%CI were extracted from the results of univariate and multivariable analyses. Results: A total of 9 articles published between 2011 to 2018 with 218,151 TKA patients were included. Of the 13 intrinsic patient factors reported, 6 met the criteria for synthesised review: age, obesity, comorbidity, gender, SF-12/VR-12 survey, and smoking. Due to the heterogeneity of statistical analysis and reporting 2 variables could undergo meta-analysis, gender and smoking. Female gender increased the likelihood of IRF discharge by 78% (OR = 1.78; 95%CI = 1.43-2.20; I2 = 33.3%), however, the relationship between smoking status and discharge destination was less certain (OR = 0.80; 95%CI = 0.42-1.50; I2 = 68.5%).

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“…Common markers of malnutrition that have been studied include low serum albumin as a marker of protein status, low total lymphocyte count (TLC), and an excessively high or low body mass index (BMI). They have been compared against various adverse surgical outcomes, including peri-prosthetic joint infection such as deep surgical site infection (SSI) or implant infection [10][11][12], delayed wound healing [4,5,13], unplanned intubation, and intensive care unit (ICU) admission [11], postoperative anemia and cardiac complications [14], and length of hospital stay [15,16]. However, conflicting results have been reported; for example, while hypoalbuminemia (serum albumin < 3.5 g/dL) has been associated with an increased risk of peri-prosthetic infection [10,11] and longer than average hospital stay [15,16] its effect on wound healing is less clear - Marín et al (2002) [13] reported no significant predictive value of hypoalbuminemia on wound healing, yet Greene et al (1991) [5] reported a five-fold increase in the frequency of major wound complications.…”

Section: Introductionmentioning

confidence: 99%

Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty

Man

Chau

Chung

et al. 2020

Knee Surg & Relat Res

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Background: Malnutrition is a common and modifiable risk factor for postoperative complications and adverse outcomes in orthopedics. The purpose of this study was to identify biomarkers of malnutrition in patients undergoing elective total knee arthroplasty (TKA) that are predictive of adverse in-hospital postoperative complications, to facilitate the identification of at-risk patients for nutritional optimization before surgery. Methods: A total of 624 patients who underwent elective TKA between 2013 and 2017 were evaluated; potential biomarkers of preoperative malnutrition, including hypoalbuminemia (serum albumin < 3.5 g/dL), total lymphocyte count (TLC < 1500 cells/mm 3), and body mass index (BMI), were assessed for any association with in-hospital postoperative complications. Results: The prevalence of hypoalbuminemia, low TLC, overweight, obesity class I, and obesity class II were, respectively 2.72%, 33.4%, 14.8%, 44.5%, and 26.9%. There was a significant association between hypoalbuminemia and obesity class II (BMI ≥ 30.0 kg/m 2) with rates of peri-prosthetic joint infection, and no significant association between such complications and low TLC, overweight, or obesity class I. Logistic regression analysis showed that patients with hypoalbuminemia or being in obesity class II with gouty arthritis were more likely to suffer from periprosthetic joint infection. Conclusions: Hypoalbuminemia and obesity class II together is a reliable biomarker of preoperative malnutrition for predicting peri-prosthetic joint infection after elective TKA, whereas low TLC, overweight, and obesity class I were not significantly associated with an increased risk of such complications.

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Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients

Cited by 29 publications

References 24 publications

Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

Risk factors associated with cardiac complication after total joint arthroplasty of the hip and knee: a systematic review

Intrinsic patient factors predictive of inpatient rehabilitation facility discharge following primary total knee arthroplasty: a systematic review and meta-analysis

Hypoalbuminemia and obesity class II are reliable predictors of peri-prosthetic joint infection in patient undergoing elective total knee arthroplasty

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