What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

Bohl, Daniel D.; Ondeck, Nathaniel T.; Basques, Bryce A.; Levine, Brett R.; Grauer, Jonathan N.

doi:10.1007/s11999-016-5224-2

Cited by 42 publications

(50 citation statements)

References 38 publications

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“…Our results are consistent with the findings of recent research from Johnson et al and BOHL et al [12,13]. Johnson et al [13] studied 1622 patients with PE after TJA based on the National Surgical Quality Improvement Program (NSQIP) database between 2011-2016, and indicated that the median day for PE following TJA was 3.…”

Section: Discussionsupporting

confidence: 92%

“…Johnson et al [13] studied 1622 patients with PE after TJA based on the National Surgical Quality Improvement Program (NSQIP) database between 2011-2016, and indicated that the median day for PE following TJA was 3. BOHL et al [12] included 625 patients with PE after TJA from 2005 to 2013 based on the above database as well. The results showed that the median day of PE was 3 postoperatively (interquartile range: 2-7).…”

Section: Discussionmentioning

confidence: 99%

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The timing of symptomatic pulmonary embolism in patients with non-warfarin following elective primary total joint arthroplasty

Hu¹,

C²,

Wang³

et al. 2019

Preprint

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Background: The purpose of this study was to investigate the incidence and timing of postoperative symptomatic pulmonary embolism (PE) in patients receiving non-warfarin following primary total joint arthroplasty (TJA), to clarify the appropriate duration of postoperative VTE prophylaxis. Methods: We retrospectively reviewed the medical records of 11148 patients who underwent primary TJA, including total knee arthroplasty (TKA) and total hip arthroplasty (THA) at our institution from January 2012 to March 2019. The median postoperative day of diagnosis of symptomatic PE and interquartile range for day of diagnosis were determined. Multivariate Cox proportional hazards modeling was used to test the difference of timing for PE based on demographics and comorbidities. Results: The overall 90-day rate of symptomatic PE was 0.71%. The median day of diagnosis for symptomatic PE was 3 day postoperatively (interquartile: 2–7 day). Factors that showed statistical significance on multivariate analysis in association with earlier timing of PE occurrence in patients with atrial fibrillation, diabetes mellitus, coronary heart disease and history of stroke. Conclusion: The vast majority symptomatic PE occurs in the early postoperative period after TJA, and atrial fibrillation, diabetes mellitus, coronary heart disease and history of stroke were independent factors affecting the timing of symptomatic PE.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The timing of symptomatic pulmonary embolism in patients with non-warfarin following elective primary total joint arthroplasty

Hu¹,

C²,

Wang³

et al. 2019

Preprint

View full text Add to dashboard Cite

show abstract

“…obtained similar results, with medians of 5 days and 4 days for pulmonary embolism, and 10.5 days and 12 days for DVT, respectively . This is also close to other observations made for orthopedic surgery: a median of 3 days for pulmonary embolism after lower‐limb arthroplasty, and 50% of thromboembolic events in the first 7 days after total shoulder arthroplasty .…”

Section: Discussionsupporting

confidence: 88%

Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients

Bouyer

Rudnichi

Dray‐Spira

et al. 2018

Journal of Thrombosis and Haemostasis

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Background Postoperative venous thromboembolism (VTE) is a severe complication, the risk of which after lumbar spine surgery (LBS) is not precisely known. Objective To estimate the incidence of VTE after LBS, and to identify individual and surgical risk factors. Methods All patients aged >18 years who underwent LBS in France between 2009 and 2014 were identified. Among 477 024 patients screened, exclusions concerned recent VTE or surgery, and multiple surgeries during the same hospital stay. Results In 323 737 patients (mean age 52.9 years, 51.4% male), we observed 2911 events (0.91%) after a median time of 12 days (Q1-Q3: 5-72 days). The multivariate adjusted Cox model showed increased risks associated with age (4% per year of age; 95% confidence interval [CI] 3.8-4.3), obesity (hazard ratio [HR] 1.32, 95% CI 1.18-1.46), active cancer (HR 1.65, 95% CI 1.5-1.82), previous thromboembolism (HR 5.41, 95% CI 4.74-6.17), severe paralysis (HR 1.47, 95% CI 1.17-1.84), renal disease (HR 1.28, 95% CI 1.04-1.6), psychiatric disease (HR 1.21, 95% CI 1.1-1.32), use of antidepressants (HR 1.13, 95% CI 1.03-1.24), use of contraceptives (HR 1.56, 95% CI 1.19-2.03), extended surgery for scoliosis (HR 3.61, 95% CI 2.96-4.4), implantation of pedicular screws with a 'dose-effect' association, and an anterior approach (HR 1.97, 95% CI 1.6-2.43) or a combined approach (HR 2.03, 95% CI 1.44-2.84). Conclusions The overall VTE risk after LBS is moderate (< 1%) but is widely modulated by several easily identifiable risk factors. The surgical community should be aware of this heterogeneity, adapt prevention according to patients and to the procedure, and use drug prophylaxis in the event of a high risk being present.

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“…To the best of our knowledge, no previous studies analyzed hospital readmissions or their economic impact in developing countries. Moreover, a 30-day interval is considered an overly short period to properly determine the consequences of a major surgical procedure [18,19]. With this as background, we performed a prospective analysis of unplanned readmissions within 90 days following spine surgery, regardless of the type or location of the procedure, in an orthopedic specialty unit.…”

Section: Introductionmentioning

confidence: 99%

Unplanned Readmissions after Spine Surgery: A Single-Center Prospective Analysis of a 90-Day Model in 2,860 Cases

Avinash¹,

Renjith²,

Shetty³

et al. 2020

Asian Spine J

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During the last decades, an emergence of unplanned readmissions has been shown to be a useful tool to gage the healthcare quality and hospital performance. Previous studies were limited by their retrospective designs based on database information and short-term 30-day follow-up intervals. We analyzed the incidence and causes for unplanned readmissions following spine surgery at a 90-day interval and the difference at 30-, 31-60-, and 61-90-day intervals after discharge. Additionally, we assessed total beddays lost and the economic impact of readmissions and probable risk factors. Overview of Literature: Recent reports on readmission rates suggested the contribution of this parameter for the assessment of healthcare quality. Methods: A prospective analysis of 2,860 admissions was performed over 1 year in a tertiary care orthopedic hospital. All unscheduled readmissions following spine surgery within 90 days of discharge were included, irrespective of type or location of surgery. Polytrauma, primary osseous infections, and planned readmissions were excluded. Results: Our readmission rate was 3.32% (95/2,860). Leading readmission causes were surgical site infections (SSIs) accounting for 44.21% (n=42; superficial, 23; deep, 11; organ and space, 8), followed by aseptic pain 31.58% (n=30) and medical causes 13.68% (n=13). Though 86.95% of superficial SSIs occurred within 30 days, 21.1% of deep SSIs occurred beyond 30 days. During the 30-90-day interval, 33.68% of readmissions occurred. The financial burden amounted to 41,93,660 Indian Rupees, and the mean bed-days lost was 7.33 per readmission. Hospital stay ≥10 days, health insurance, and comorbid illnesses (diabetes, hypertension, and liver disease) were associated with readmissions (p<0.05). Conclusions: Our study showed that SSIs and aseptic pain were the leading causes of readmissions at 90 days after spine surgery. Limiting the analysis to 30-day readmissions as in previous studies would lead to failure in the identification of more severe complications like deep SSIs. Continued vigilance, particularly for patients with predisposing factors, could help alleviate the financial burden.

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What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

Abstract: Background Despite extensive research regarding risk factors for adverse events after total joint arthroplasty (TJA), there are few publications describing the timing at which such adverse events occur.

Cited by 42 publications

References 38 publications

The timing of symptomatic pulmonary embolism in patients with non-warfarin following elective primary total joint arthroplasty

The timing of symptomatic pulmonary embolism in patients with non-warfarin following elective primary total joint arthroplasty

Thromboembolic risk after lumbar spine surgery: a cohort study on 325 000 French patients

Unplanned Readmissions after Spine Surgery: A Single-Center Prospective Analysis of a 90-Day Model in 2,860 Cases

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