Perioperative Morbidity and Mortality of Same-admission Staged Bilateral TKA

Abstract

Background Controversy continues regarding the optimal timing of surgery for patients with symptomatic bilateral degenerative knee arthritis who are not considered eligible for same-day bilateral TKA (BTKA). Questions/purposes We compared (1) 30-day mortality; (2) rates of in-hospital complications; and (3) blood transfusion rates between patients undergoing sameadmission staged BTKA and patients undergoing BTKA staged within 1 year in a highly specialized center where specific guidelines have been implemented for same-day BTKA patient selection. Methods We analyzed institutional data for 149 patients undergoing same-admission staged and 1557 patients undergoing staged BTKA diagnosed with bilateral knee idiopathic osteoarthritis from 1998 to 2011. Although patients in both groups presented with bilateral knee disease, same-admission staged patients had more medical comorbidities and did not qualify for same-day BTKA. Specifically, patients with coronary artery disease with inducible ischemia, congestive heart failure, advanced chronic obstructive pulmonary disease, uncontrolled diabetes, peripheral vascular disease, renal failure, morbid obesity, history of venous thromboembolism, or those who were older than 75 years were not considered eligible for same-day BTKA. Patient demographics and Deyo comorbidity index were tabulated. The groups were similar in age, but same-admission staged patients were more likely to be male and had a higher overall comorbidity burden. The complications were categorized into systemic (medical) and local (orthopaedic). Furthermore, the systemic complications were subcategorized into major (required complex surgical or medical intervention or were deemed life-threatening) and minor (necessitated additional observation or required medical treatment), depending on their severity. Regression models were conducted to examine the association between surgery type and development of complications.Results There was no difference in 30-day mortality between the groups (0% versus 0.06%; p = 0.754). There was no difference in the local complication rates (0.7% versus 0.8%; p = 1.000). However, multivariable regression analysis adjusting for age, sex, and Deyo comorbidity index showed that same-admission staged patients were Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. 123Clin Orthop Relat Res (2015) 4...

Life expectancy of osteoarthritic patients after primary total knee arthroplasty

“…[8][9][10] Although many studies have reported short-term mortality after TKA, many of them primarily compared the outcomes among unilateral TKA and simultaneous and staged bilateral TKAs. [11][12][13][14][15][16][17] However, several studies have analyzed mid-term or long-term patient survival after TKA. Based on those reports, rheumatoid arthritis (RA), 9 ,10,18,19 male sex, 9 ,10 age 9,10,19,20 , American Society of Anesthesiologist (ASA) grade, 19 ,21 body mass index (BMI), 19 diabetes, 8 and history of smoking 19 of patients undergoing TKA are reported to be linked to increased mortality in populations mainly from the US 8 and European countries.…”

A nationwide comparison of staggered and simultaneous bilateral knee arthroplasty during a single hospitalization: Trends, risks and benefits

“…Similarly, Poultsides et al. reported that the incidence of wound infection was 3 times higher in the simultaneous group than in the staged group [ 16 ].…”

“…However, evidence about the efficacy and safety of staggered bilateral KA is very limited. According to a meta-analysis that compared the postoperative outcomes of staggered bilateral KA, simultaneous bilateral KA and staged bilateral KA, only five relevant articles were found and they offered conflicting results [ [16] , [17] , [18] , [19] , [20] ]. Two studies indicated that staggered bilateral KA had significantly superior outcomes than simultaneous bilateral KA [ 17 , 18 ], and one study suggested that staggered bilateral KA was correlated with more complications than simultaneous bilateral KA [ 20 ].…”

Short‐term high‐dose intravenous iron reduced peri‐operative transfusion after staggered bilateral total knee arthroplasty: A retrospective cohort study

“…Staggered bilateral TKA is a surgical strategy wherein two procedures are performed on two different operative days within a 4–7‐day interval. This strategy has advantages over staged bilateral TKA, wherein two unilateral knee replacement arthroplasties are performed within 1 year at different hospitalization schedules [7]; that is, the surgery of both knees can be accomplished during a single hospitalization, thereby decreasing the overall recovery time and hospitalization for replacement of both knees [18]. However, a previous study showed that staggered bilateral TKA results in more acute post‐operative anaemia (11% vs. 3%) and blood transfusions (93% vs. 54%) compared with staged bilateral TKA [18].…”

“…This strategy has advantages over staged bilateral TKA, wherein two unilateral knee replacement arthroplasties are performed within 1 year at different hospitalization schedules [7]; that is, the surgery of both knees can be accomplished during a single hospitalization, thereby decreasing the overall recovery time and hospitalization for replacement of both knees [18]. However, a previous study showed that staggered bilateral TKA results in more acute post‐operative anaemia (11% vs. 3%) and blood transfusions (93% vs. 54%) compared with staged bilateral TKA [18]. The causes of post‐operative anaemia can be the presence of pre‐existing anaemia, surgical blood loss, and surgery‐related inflammation, which may blunt erythropoiesis for recovery.…”