Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

Memtsoudis, Stavros G.; Salvati, Eduardo A.; Go, George; Ma, Yan; Sharrock, Nigel E.

doi:10.1097/aap.0b013e3181e85a07

Cited by 33 publications

(26 citation statements)

References 17 publications

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“…The preexisting decreased vascular reserve of the lungs, specifically the load-dependent response and capacity of the lungs to absorb the embolic insult, has been previously documented in healthy patients undergoing bilateral TKAs [19]. The ability of the pulmonary vascular bed to compensate may be overwhelmed by the larger embolic load of two consecutively performed arthroplasties.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…Exclusion criteria were general contraindications for surgery, a history of hip arthrodesis, ASA category 4 disease or greater, and revision surgery.Baseline Hb levels were optimized using iron supplementation and erythropoietin (EPO) if Hb level was ≤ 14.0 g/dl. In addition, postoperative iron therapy to compensate the intraoperative blood loss was provided, and we made use of a cellsaver for the reinfusion of autologous blood [15, 16]. The latter was performed as an immediate autologous blood transfusion postoperatively, which is associated with a significant decrease in the need for homologous blood transfusion [17].…”

Section: Methodsmentioning

confidence: 99%

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

Petridis¹,

Nolde²

2017

TOORTHJ

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Background:Sequential bilateral total hip arthroplasty (THA) has the potential advantages of a single operative intervention with a single hospital stay, alongside reduced costs and total rehabilitation times. Its use has been limited, however, by a theoretical increase in perioperative complications.Objective:The purpose of this study was to assess functional outcomes and complications in patients undergoing sequential bilateral THA performed using anterior minimally invasive surgery (AMIS). We hypothesized that sequential bilateral THA yields favorable clinical outcome and is safe to perform.Methods:Two surgical centres conducted a retrospective observational analysis of 130 patients (77 females) with a mean age of 57 (range, 35-77) years, all of whom were treated by one surgeon and followed up for 24 months.Results:The mean length of hospital stay length was 8.4 (range, 6–18) days. The mean operative time was 162 (range, 92–185) minutes, the mean intraoperative blood loss was 499.1ml, and the mean preoperative and postoperative hemoglobin levels were 14.3 g/dl and 11.3 g/dl, respectively. No perioperative complications or deaths were recorded. The Harris Hip Score (HHS) improved from 44.5 ±13.7 preoperatively to 98.9 ± 1.0 at final follow-up. Also the High Activity Arthroplasty Score (HAAS) and the Questions on Life Satisfaction (FLZ) score improved significantly.Conclusion:This retrospective analysis suggests that, in selected patients, sequential bilateral THA via an anterior minimally invasive approach appears to be a valid alternative to two-stage bilateral THA. Further studies are warranted.

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“…Pulmonary hypertension is a particularly hazardous condition in conjunction with anesthesia and surgery, as it is known to be associated with dramatically higher complication rates and mortality due to right ventricular failure, myocardial ischemia, or arrhythmia [35]. Importantly, this effect might be compounded by strain on the right heart system invoked by embolization of bone debris, blood clots, bone marrow, and bone cement during bone instrumentation, which has been shown to increase pulmonary vascular resistance [36]. Our group demonstrated an approximately 4-to 4.5-fold increased risk of perioperative mortality in patients with pulmonary hypertension receiving total hip or knee arthroplasty, respectively, compared to their counterparts with no such diagnosis (2.4% versus 0.6% and 0.9% versus 0.2%) [37].…”

Section: Focus On Other Comorbiditiesmentioning

confidence: 99%

Outcomes Research in Perioperative Medicine

Stundner

Memtsoudis

2014

Advances in Anesthesiology

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Outcomes research is emerging as an invaluable approach to the scientific evaluation of healthcare in a real-world rather than an experimental environment. There is much interest in the differential evaluation of existing interventions with regard to different patient populations. Moreover, various comorbid conditions necessitate analysis for the specific additional risk those factors convey in the perioperative arena, a task often difficult to accomplish without population-based techniques. The authors' group has conducted significant work in perioperative outcomes research utilizing CER and database analysis methodology, with focus on orthopedic surgery and anesthesiology. Our research resulted in numerous publications affecting policy and patient care over the last number of years. Knowledge on immediate perioperative outcomes of anesthesia and surgery is of very high interest not only to clinicians but also to administrators and policymakers, as it allows for risk assessment and allocation of resources. This review is not intended to be a systematic review but rather to (1) provide a brief overview over the theoretical basis of CER and populationbased database research, (2) give an overview of our work with various points of focus, and (3) offer a perspective on the future development in perioperative medicine.

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Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

Cited by 33 publications

References 17 publications

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

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

Sequential Bilateral Total Hip Arthroplasty Through a Minimally Invasive Anterior Approach is Safe to Perform

Outcomes Research in Perioperative Medicine

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