Postoperative Complications Causing Readmission in 30 Days after Total Knee Arthroplasty: A Retrospective Nested Case-Control Study of Risk Factors Based on Propensity Score Matching

Abstract

We performed this study to identify independent risk factors for life-threatening postoperative complications causing 30-day readmissions after total knee arthroplasty (TKA). Improved understanding of these risks may improve efficiency and safety of treatment. We performed a retrospective, nested case-control study using an open-access database of 2,622 patients who underwent primary TKA at a tertiary academic medical center in Singapore between January 2013 and June 2014. Patients were grouped according to the incidence of complications. Multivariate logistic analysis was performed to identify predictive factors for TKA complications. The incidence of postoperative complications was 1.72%. Compared with cases performed with an operative time < 70 minutes, increased operative time was associated with a higher risk of complications. Case duration > 90 minutes was associated with an increased risk (adjusted odds ratio [aOR] = 4.57, p = 0.001; case duration ≥ 111 minutes, aOR = 4.64, p = 0.04; and case duration between 91 and 110 minutes, aOR = 3.20, p = 0.03). The correlation between operative time and complications was nonlinear. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) was an independent risk factor for increased complication rate (aOR = 11.59, p = 0.02). Operative duration has been identified as an independent risk factor for complications after TKA. As it remains a modifiable factor to which doctors are interested in bringing quality improvement, the risk of postoperative complications will be reduced by minimizing the operative duration.

Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty

“…diabetes mellitus [23] , cerebrovascular disease [22][23][24] , and cirrhosis [22] are risk factors for complications after primary total knee and hip arthroplasty. In our study, arrhythmia and cerebrovascular disease was an independent risk factor of severe postoperative complications.…”

Cerebral mechanism of opposing needling for managing acute pain after unilateral total knee arthroplasty: study protocol for a randomized, sham-controlled clinical trial

“…It can effectively relieve pain, restore knee joint function, and improve quality of life, posture, and balance [ 3 , 4 ]. Nevertheless, the potential postoperative complications following TKA, such as infection, pain, venous thrombosis, and fracture, are cause for concern for both surgeons and patients; therefore, it is necessary to control and reduce the incidence of these complications [ 5 ]. In the early stage of recovery after TKA, severe acute pain will occur [ 6 ], and inadequate pain management can delay the recovery process and may be accompanied by greater risks such as poor wound healing, prolonged hospitalization, unnecessary psychological stress, and reduced satisfaction.…”