Preoperative Risk Factor Optimization Lowers Hospital Length of Stay and Postoperative Emergency Department Visits in Primary Total Hip and Knee Arthroplasty Patients

Dlott, Chloe C.; Moore, Anne; Nelson, Christen; Stone, Dannielle; Xu, Yi; Morris, Jensa; Gibson, David; Rubin, Lee E.; O’Connor, Mary I.

doi:10.1016/j.arth.2020.01.083

Cited by 59 publications

(65 citation statements)

References 25 publications

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“…Interestingly, shorter hospital LOS had a significantly positive effect on the RTW. It is known that preoperatively optimized patients in terms of modifiable aspects of their health have shorter LOS after primary hip arthroplasty surgery 25,26 . It is therefore likely that healthier patients have a shorter hospital LOS thus a lower risk for an unsuccessful RTW after THA.…”

Section: Discussionmentioning

confidence: 99%

Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

Hauer

Smolle

Zaussinger

et al. 2021

Sci Rep

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Return to work (RTW) has been specifically identified as a high priority in patients undergoing total hip arthroplasty (THA). This investigation sought to assess the effect of the stem design on patients’ RTW. Secondly, the study aimed to identify risk factors that lead to a delayed RTW. Questionnaires inquiring about RTW, employment history, educational level, type of work, physical demands and joint awareness were administered by post. Further data were collected from patients’ hospital records. 176 patients who underwent THA using a short-stem and 97 patients using a straight-stem design were compared. The median return to work time was 10 weeks [IQR 7–14 weeks], with no significant difference between the two groups (short stems vs. straight stems; 10 [IQR 7–14] vs. 11 [7.5–13.5] weeks; p = 0.693). In the multivariate linear regression analysis, self-employment vs. employee (p = 0.001), dimension of preoperative workload (p = 0.001), preoperative sick leave (p < 0.001), and hospital length of stay (LOS) (p < 0.001) independently affected the period until work was resumed. The Forgotten-Joint-Score-12 showed no significant difference between the two groups. The data show that the majority of THA patients can expect to resume work and stem design has no impact on RTW. Employees with preoperative sick leave, prolonged hospital LOS and low workload are at higher risk for a delayed RTW.

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Section: Discussionmentioning

confidence: 99%

Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

Hauer

Smolle

Zaussinger

et al. 2021

Sci Rep

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“…Our study agrees with current literature that demonstrates patients with a history of chronic heart failure, angina, hypertension requiring medication, percutaneous intervention including stent placement, or previous cardiac surgery are at an increased risk for developing myocardial infarction (MI) following TJA. 12 In our analysis, history of cardiac comorbidities lead to an increased risk of CA, including MI and other inciting events.…”

Section: History Of Cardiac Comorbiditiesmentioning

confidence: 96%

Preoperative risk factors for postoperative cardiac arrest following primary total hip and knee arthroplasty: A large database study

Kataria

Iniguez

Foy

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Background: Cardiac arrest (CA) has been identified as a potential complication following Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). This retrospective, case-controlled study aims to identify risk factors in order to improve the management of patients undergoing THA or TKA with known preoperative comorbidities. Methods: CPT codes were used to investigate the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent THA or TKA from 2010 to 2017. Patients were classified as having cardiac arrest (CA) by the NSQIP guidelines. Patient samples with all possible covariates were included for the multivariate logistic regression analysis and assessed for independent association. Results: Patients receiving perioperative transfusion, experiencing dyspnea with moderate exertion, dyspnea at rest, patients currently on dialysis, and patients aged 72 are all independently associated with increased rates of cardiac arrest (CA) following THA. Patients receiving perioperative transfusion, patients with anemia, bleeding disorders, dyspnea with moderate exertion, cardiac comorbidities, pulmonary comorbidities, and patients aged 73 are all associated with increased rates of cardiac arrest (CA) following TKA. Conclusion: Patients with the identified risk factors are at a greater risk of suffering cardiac arrest within 30 days following THA and TKA. It is imperative that we recognize which risk factors may precipitate CA in THA and TKA recipients so that prophylactic management can be employed. Furthermore, management guidelines should be updated for patients at high risk of CA following THA and TKA to prevent this complication.

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“…[18][19][20][21][22][23] Although relatively sparse compared with other surgical specialities, optimisation programs for THR and TKR, such as pre-operative rehabilitation (prehabilitation), fast-track or enhanced recovery after surgery (ERAS) protocols have been developed and tested. [24][25][26][27][28] A recent review of optimisation prior to knee replacement concluded that there is some, though limited, evidence that optimisation may improve outcomes post-surgery. 17 Indeed, prehabilitation through patient education and exercise can improve patient-reported outcomes such as shorter hospital stay after THR/TKR, less postoperative pain and function after THR, greater quadriceps muscle strength after TKR.…”

Section: Introductionmentioning

confidence: 99%

Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

Chang

Naylor

Liu

et al. 2021

Preprint

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Introduction: Emerging evidence suggests that fast-track and enhanced recovery after surgery (ERAS) targeting modifiable risk factors reduce complications after total hip (THR) and knee replacement (TKR). However, what constitutes an effective preoperative optimisation protocol for THR and TKR remains unclear. The aims are to: (1) describe pre-operative optimisation protocols for THR and TKR; (2) evaluate the effects of pre-operative optimisation protocols for THR and TKR on morbidity, and patient-reported outcomes. Methods and analysis: Systematic review and meta-analysis. Electronic databases will be searched using pre-determined search terms to identify relevant studies and evaluate the study eligibility and risks of bias. Two independent reviewers will select the eligible studies and any disagreement will be resolved through a third reviewer. We will include studies investigated pre-operative optimisation protocols administered prior to participants receiving primary THR or TKR to improve post-operative outcomes. Primary outcomes are hospital readmission, complications and patient-reported pain and function. Risk of bias will be assessed using the Cochrane RoB 1 tool and strength of evidence will be examined using the GRADE approach. Pre-operative optimisation protocols will be summarised qualitatively. Meta-analyses on the effects of included protocols will be conducted if appropriate. Ethics and dissemination: This systematic review does not require ethics approval. The findings will be disseminated in a peer-reviewed journal and presented at relevant conferences. Registration: This protocol has been submitted to the International Prospective Register of Systematic Reviews on 30 August 2021.

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Preoperative Risk Factor Optimization Lowers Hospital Length of Stay and Postoperative Emergency Department Visits in Primary Total Hip and Knee Arthroplasty Patients

Cited by 59 publications

References 25 publications

Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

Short-stem total hip arthroplasty is not associated with an earlier return to work compared to a straight-stem design

Preoperative risk factors for postoperative cardiac arrest following primary total hip and knee arthroplasty: A large database study

Preoperative optimisation in fast-track and enhanced recovery after surgery (ERAS) programs for total hip and knee joint replacement: a systematic review protocol

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