Utilization of Critical Care Services among Patients Undergoing Total Hip and Knee Arthroplasty

Abstract

Background A paucity of data exist on the use of critical care services (CCS) among hip and knee arthroplasty patients. The authors sought to identify the incidence and risk factors for the use of CCS among these patients and compare the characteristics and outcomes of patients who require CCS to those who do not. Methods The authors analyzed hospital discharge data of patients who underwent primary hip or knee arthroplasty in approximately 400 United States hospitals between 2006 and 2010. Patient and healthcare system-related demographics for admitted patients requiring CCS were compared with those who did not. Differences in outcomes, including mortality, complications, disposition status, and hospital charges, were analyzed. Regression analysis was performed to identify risk factors for requiring CCS. Results A total of 528,495 patients underwent primary total hip (n = 172,467, 33%) and knee arthroplasty (n = 356,028, 67%). Of these, 3% required CCS. On average, CCS patients were older and had a higher comorbidity burden than did patients not requiring CCS. CCS patients experienced more complications, had longer hospital stays and higher costs, and were less likely to be discharged home than were non-CCS patients. Risk factors with increased odds for requiring CCS included advanced age, use of general versus neuraxial anesthesia, and the presence of postoperative cardiopulmonary complications. Conclusions Approximately 1 of 30 patients undergoing total joint arthroplasty requires CCS. Given the large number of these procedures performed annually, anesthesiologists, orthopedic surgeons, critical care physicians, and administrators should be aware of the attendant risks this population represents and allocate resources accordingly.

The Impact of Sleep Apnea on Postoperative Utilization of Resources and Adverse Outcomes

“…Before distribution, rigorous quality assurance and data validation procedures are employed by the provider to assure the accuracy of entries. This database has previously been used for other studies by our group 11,12 .…”

“…Due to their skewed distributions, they were also dichotomized such that entries exceeding the 75 th percentile were defined as increased length of hospitalization or increased use of economic resources, respectively. This approach was used by our group in various other publications 11,12 . Further, using this cutoff was not influenced by the length of hospitalization or patient costs of SA patients.…”

Sleep Apnea and Total Joint Arthroplasty under Various Types of Anesthesia

“…This study was exempt from consent requirements by the Hospital for Special Surgery Institutional Review Board as data are deidentified and in accordance with the Health Insurance Portability and Accountability Act. 7 The same data set was used previously by our group for various other projects, including the evaluation of rates of critical care utilization in patients receiving total joint arthroplasty 8 and differential outcomes in patients undergoing unilateral hip or knee 9 or bilateral total knee arthroplasty. 10 However, it had not been used to evaluate the impact of anesthesia-specific information on outcomes in SA patients undergoing hip and knee arthroplasty.…”

Sleep apnoea adversely affects the outcome in patients who undergo posterior lumbar fusion

“…Rigorous quality assurance and data validation checks were performed by the provider before distribution in order to ensure accuracy of the entries. This database has previously been used to assess the incidence and risk factors for critical care service use among patients undergoing total hip (THR) and knee replacement (TKR),[[9]] and to determine comparative peri-operative outcomes associated with neuraxial versus general anaesthesia in patients undergoing simultaneous bilateral TKR. [[10]]…”