Background Studies suggest a trend in the selection of younger and healthier individuals to undergo bilateral TKAs in an attempt to diminish the incidence of complications. It remains unclear whether this development has reduced overall perioperative morbidity and mortality.Questions/purposes We investigated whether changes in demographics and comorbidity patterns of patients undergoing bilateral TKAs are detectable and coincide with changes in length and cost of hospitalization, incidence of perioperative complications, morbidity, and mortality.The institution of one of the authors (MM) has received funding, during the study period, from the Clinical Translational Science Center, National Center for Advancing Translational Sciences (NCATS) (Grant UL1-RR024996), and the Center for Education, Research, and Therapeutics, Agency for Healthcare Research and Quality (AHRQ) (Grant U18 HSO16-75). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding sources NCATS and AHRQ, Rockville, MD, USA. One of the authors (SGM) certifies that he, or a member of his immediate family, has received or may receive funding supporting research related expenses, during the study period, from the
123Clin Orthop Relat Res (2013) 471:17-25 DOI 10.1007/s11999-012-2608 Clinical Orthopaedics and Related Research ®
A Publication of The Association of Bone and Joint Surgeons®Methods We accessed Nationwide Inpatient Survey data files between 1999 and 2008. One-year periods were created and changes in demographics, length of in-hospital stay, and perioperative morbidity and mortality were analyzed. Results An estimated 258,524 bilateral TKAs were performed between 1999 and 2008 in the United States. The number of annual procedures increased from 19,288 to 33,679 (75%). Length of hospital stay decreased from 4.98 to 4.01 days. Absolute in-hospital mortality rates decreased at an average rate of 10% per year. The unadjusted percent and adjusted incidence per 1000 inpatient days decreased from 0.42% and 0.85 to 0.16% and 0.39. Although the unadjusted incidence of pneumonia, pulmonary embolism, and nonmyocardial infarction cardiac complications did not change, an increase with time was detectible after adjustment for length of stay. No changes in adjusted incidence were seen for other complications. Conclusions Although a decreased incidence was seen for some major complications, others either remained unchanged or had an increased incidence when adjusted for length of stay. Future interventions should focus on reducing perioperative risk to improve patient safety.