Risk Factors for Unplanned Admission to the Intensive Care Unit After Elective Total Joint Arthroplasty

Sukhonthamarn, Kamolsak; Grosso, Matthew J.; Sherman, Matthew; Restrepo, Camilo; Parvızı, Javad

doi:10.1016/j.arth.2020.03.003

Cited by 26 publications

(24 citation statements)

References 10 publications

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“…BMI > 30) are found to be associated with unexpected postoperative ICU admission 29,30 . Some procedure-specific risk factors are also linked to unplanned ICU admission, for example, revision surgery for total hip arthroplasty or total knee arthroplasty 31 . In brief, most studies are retrospective in design and show that age, BMI, ASA classification, type of procedure (or surgical risk), duration of surgery, emergency surgery, revision operation, estimated blood loss, anemic status and specific comorbidities may relate to postoperative ICU admission.…”

Section: Discussionmentioning

confidence: 99%

Surgical Apgar score is strongly associated with postoperative ICU admission

Lin

Chen

Yang

et al. 2021

Sci Rep

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Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.

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Section: Discussionmentioning

confidence: 99%

Surgical Apgar score is strongly associated with postoperative ICU admission

Lin

Chen

Yang

et al. 2021

Sci Rep

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“…While not largely investigated, previous studies have examined independent risk factors for ICU admission in the setting of arthroplasty (►Table 7). 11,12,[18][19][20] However, the current study is the first to assess the risk of ICU admission in multiple surgical settings. This factor becomes important during surgical planning when determining which patients are able to undergo arthroplasty in the ambulatory setting and those who will likely require ICU care.…”

Section: Discussionmentioning

confidence: 99%

“…Investigators of the previous study examined the occurrence of revision or mortality within 90 days following arthroplasty, 28 whereas we focused on the requirement of ICU admission in the immediate postoperative setting. Oh et al 16 cited an Table 7 Summary of previously cited independent risk factors for ICU admission after total joint arthroplasty 11,18,42 AbdelSalam et al 42 Kamath et al 11 Sukhonthamarn showed patients with depression faced an increased risk of periprosthetic joint infection, need for additional revision, and increased resource use and costs. Findings within the previous literature may be explained by the association of smoking, 31 alcohol abuse, 32 and poor nutrition 33 with mental health disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Increased resource use secondary to complications following joint reconstruction has been well documented in the literature 16,17 ; however, limited studies have investigated the risk factors of unplanned ICU admission following lower limb arthroplasty. 11,12,[18][19][20] To our knowledge, no study has examined the risk factors of ICU admission in multiple surgical settings nor considered preoperative orthopaedic outcome scores when assessing this risk. As the rates of primary and revision arthroplasty continue to rise, preoperative risk stratification of the complex patient population seen in the setting of arthroplasty has become increasingly important for both patient safety and cost-effective allocation of resources.…”

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confidence: 99%

See 1 more Smart Citation

Can We Predict Unplanned Intensive Care Unit Admission in Hip and Knee Arthroplasty?

Sinclair

Briskin

Klika

et al. 2021

The Journal of Hip Surgery

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Preoperative risk stratification remains important for both patient safety and cost-effective allocation of resources in total joint arthroplasty. Limited literature exists investigating risk factors for unplanned intensive care unit (ICU) admission following arthroplasty. Therefore, the purpose of this study was to assess a broader spectrum of factors that may increase the risk of ICU admission across multiple surgical settings. We retrospectively reviewed 18,169 patients who underwent a hip (40.7%) or knee (59.3%) arthroplasty procedure (primary: n = 13,384, 90%; revision: n = 1,485, 10%) between August 1, 2015, and January 31, 2019, across nine sites at a single institution. Patient demographics, laboratory data, surgical parameters, and preoperative scores on the Hip Disability and Osteoarthritis Outcome Score (HOOS) or Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Veterans RAND 12-Item Health Survey (VR-12) were recorded. A univariate analysis was conducted to identify differences between patients who required an ICU admission and those with no ICU involvement. Logistic regression was then used to generate predicted risk of ICU Involvement. A total of 147 patients (0.99%) required an ICU admission. Increasing age, higher Charlson's comorbidity index, American Society of Anesthesiologists (ASA) class 3 or greater, elevated blood urea nitrogen (BUN), elevated creatinine, decreased preoperative hemoglobin level, general anesthesia, surgical setting, revision procedure, and lower baseline scores on the KOOS Quality of Life (QOL) subscale (17 vs. 22.5, p = 0.032), VR-12 physical component score (PCS; 24.4 vs 27.1, p = 0.001), and VR-12 mental component score (MCS; 45.9 vs. 49.6, p = 0.003) were associated with a statistically significant increase in the risk of ICU admission. As performance of arthroplasty shifts in both the setting of care and the complexity of patients, identifying patients most at risk of requiring higher acuity of care is important. Preoperative assessment of comorbidities, kidney function, surgical setting, KOOS QOL subscale score, and VR-12 scores may provide guidance for the improvement of value-based care pathways.

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“…How one defines and measures success gets to the heart of the study by Gwynne-Jones and colleagues [1]. They conducted a 5-year follow-up study of two cohorts of participants who were judged not to be candidates for total knee arthroplasty (TKA) at the baselinedthose who did not undergo TKA over the ensuing 5 years and those who had TKA at some point during the 5 years of follow-up [1]. A total of 69% of the baseline sample of 120 participants were included in the longitudinal study.…”

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confidence: 99%