Patient-Reported Allergies Predict Worse Outcomes After Hip and Knee Arthroplasty: Results From a Prospective Cohort Study

Otero, Jesse E.; Graves, Christopher; Gao, Yubo; Olson, Tyler S.; Dickinson, Christopher C.; Chalus, Rhonda J.; Vittetoe, David A.; Goetz, Devon D.; Callaghan, John J.

doi:10.1016/j.arth.2016.07.040

Cited by 38 publications

(39 citation statements)

References 14 publications

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“…We identified several preoperative patient characteristics associated with delayed hospital discharge. Our finding that the number of self-reported allergies (a potential surrogate for psychological distress 34 ) was strongly associated with extended LOS is consistent with the growing notion regarding lower-limb arthroplasty that patients with self-reported allergies have worse postoperative functional outcomes and quality of life 13, 15, 33. In our study, the risk of extended LOS increased by 20% for every additional allergy reported.…”

Section: Discussionsupporting

confidence: 90%

Delayed hospital discharge after total shoulder arthroplasty: why, and who is at risk?

et al. 2019

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BackgroundThere is growing policy interest in reducing the length of stay (LOS) after discretionary orthopedic surgery but few data to guide improvement efforts. We characterized the primary reasons and predisposing factors associated with extended LOS after elective total shoulder arthroplasty.MethodsWe retrospectively identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017. Extended LOS was defined as a stay greater than the 75th percentile. Medical records were manually reviewed to ascertain the primary reason for extended LOS. Multivariable logistic regression modeling was used to determine preoperative characteristics associated with prolonged hospitalization.ResultsThe most common reason for extended LOS was pain (41%), followed by medical problems (39%), limited social support (18%), and blood transfusions (2%). Only 41% of patients with delayed discharges had documented adverse events (any medical or surgical problem), all of which were minor. The top 4 medical issues were transient hypoxemia (42%), nausea and/or vomiting (13%), electrolyte abnormalities (12%), and altered mental status (10%). In decreasing order of magnitude, the predictors of prolonged LOS were greater number of self-reported allergies, female sex, unmarried patient, diabetes, lower American Shoulder and Elbow Surgeons score, depression, reverse shoulder arthroplasty, and American Society of Anesthesiologists score of 3 or greater. Operative time did not correlate with LOS.ConclusionsProlonged hospitalizations after shoulder arthroplasty are commonly related to pain and limited social support. Sociodemographic and psychological factors seem to have more influence than patient infirmity and technical issues. These findings support a comprehensive approach to care with attention to the physical, mental, and social determinants of health.

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Section: Discussionsupporting

confidence: 90%

Delayed hospital discharge after total shoulder arthroplasty: why, and who is at risk?

et al. 2019

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“…While the reasons for this disparity were not initially clear, recent insights about the pharmacodynamic synergy of β-lactams with the innate immune system suggested that the absence of such effects among non-β-lactam drug repertoire available for MRSA treatment may be responsible (6). The consistent inferior performance of VAN compared with β-lactams in MSSA bacteremia (5, 20–23), coupled with the negative clinical prognosis conferred upon patients with β-lactam drug allergies who are denied β-lactam treatment (24–27), appeared to reinforce this conclusion.…”

Section: Discussionmentioning

confidence: 95%

Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia

Geriak

Haddad

Rizvi

et al. 2019

Antimicrob Agents Chemother

119

112

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“…Prior studies indicate that increasing amounts of PRA’s is associated with worse outcomes following total hip and knee arthroplasty[22-24]. Interestingly, the patient reported “allergy” is often a misnomer as only 15% of PRA’s studied in a community hospital setting represented a true IgE mediate hypersensitivity reaction[25].…”

Section: Discussionmentioning

confidence: 99%

“…As the relationship between PRA and psychiatric disorders is further elucidated, their impact on all aspects of TJA is becoming more apparent. In a prospective study of 446 patients undergoing primary hip and knee arthroplasty, Otero el al [22] found that patients reporting at least 1 allergy had significantly lower postoperative SF-36 physical component score compared to those reporting no allergies. In a retrospective review, McLawhorn et al[23] demonstrated that increasing number of PRAs was associated with both worse satisfaction and Western Ontario and McMaster Universities Arthritis Index scores, in addition to increased LOS following TKA in a CPP.…”

Section: Discussionmentioning

confidence: 99%

Socio-demographic factors impact time to discharge following total knee arthroplasty

Ihekweazu¹,

Sohn²,

Laughlin³

et al. 2018

WJO

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AIMTo determine social, logistical and demographic factors that influence time to discharge in a short stay pathway (SSP) by following total knee arthroplasty (TKA).METHODSThe study included primary TKA’s performed in a high-volume arthroplasty center from January 2016 through December 2016. Potential variables associated with increased hospital length of stay (LOS) were obtained from patient medical records. These included age, gender, race, zip code, body mass index (BMI), number of pre-operative medications used, number of narcotic medications used, number of patient reported allergies (PRA), simultaneous bilateral surgery, tobacco use, marital status, living arrangements, distance traveled for surgery, employment history, surgical day of the week, procedure end time and whether the surgery was performed during a major holiday week. Multivariate step-wise regression determined the impact of social, logistical and demographic factors on LOS.RESULTSEight hundred and six consecutive primary SSP TKA’s were included in this study. Patients were discharged at a median of 49 h (post-operative day two). The following factors increased LOS: Simultaneous bilateral TKA [46.1 h longer (P < 0.001)], female gender [4.3 h longer (P = 0.012)], age [3.5 h longer per ten-year increase in age (P < 0.001)], patient-reported allergies [1.1 h longer per allergy reported (P = 0.005)], later procedure end-times [0.8 h longer per hour increase in end-time (P = 0.004)] and Black or African American patients [6.1 h longer (P = 0.047)]. Decreased LOS was found in married patients [4.8 h shorter (P = 0.011)] and TKA’s performed during holiday weeks [9.4 h shorter (P = 0.011)]. Non-significant factors included: BMI, median income, patient’s living arrangement, smoking status, number of medications taken, use of pre-operative pain medications, distance traveled to hospital, and the day of surgery.CONCLUSIONThe cost of TKA is dependent upon LOS, which is affected by multiple factors. The clinical care team should acknowledge socio-demographic factors to optimize LOS.

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Patient-Reported Allergies Predict Worse Outcomes After Hip and Knee Arthroplasty: Results From a Prospective Cohort Study

Cited by 38 publications

References 14 publications

Delayed hospital discharge after total shoulder arthroplasty: why, and who is at risk?

Delayed hospital discharge after total shoulder arthroplasty: why, and who is at risk?

Clinical Data on Daptomycin plus Ceftaroline versus Standard of Care Monotherapy in the Treatment of Methicillin-Resistant Staphylococcus aureus Bacteremia

Socio-demographic factors impact time to discharge following total knee arthroplasty

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