Which Postoperative Day After Total Joint Arthroplasty Are Catastrophic Events Most Likely to Occur?

Johnson, Daniel J.; Hartwell, Matthew J.; Weiner, Joseph A.; Hardt, Kevin D.; Manning, David W.

doi:10.1016/j.arth.2019.05.033

Cited by 10 publications

(17 citation statements)

References 27 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. BOHL et al [12] included 625 patients with PE after TJA from 2005 to 2013 based on the above database as well.…”

Section: Discussionsupporting

confidence: 92%

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%

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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“…Gill et al, found a median time for DVT of 16 days in THA and 14 days in TKA in a cohort of more than 13,000 patients in the United Kingdom 71 . Using United States data, several studies have confirmed these findings 68,72-74 . Bohl et al, found patients undergoing TKA had an earlier time to PE (day 3 vs. 5 in THA) and DVT (day 5 vs. 13) 72 .…”

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 82%

“…Bohl et al, found patients undergoing TKA had an earlier time to PE (day 3 vs. 5 in THA) and DVT (day 5 vs. 13) 72 . Johnson et al, reviewed 341,601 primary THA and TKA patients 73 . Of patients who had a PE, those who underwent a TKA had a PE earlier than those who underwent a THA (81,7% during the first 10 days, vs. 58.8%).…”

Section: - Is There a Difference In Vte Risk Profile For Patients Und...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Hip & Knee

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Hip & Knee Delegates* 1 -Is VTE after elective total joint arthroplasty a "never event"?Response/Recommendation: Venous thromboembolism (VTE) after elective total joint arthroplasty (TJA) continues to occur despite various strategies in prophylaxis and should not be considered a "never event."Strength of Recommendation: Moderate.Delegates vote: Agree 94.87% Disagree 5.13% Abstain 0.00% (Strong Consensus).Rationale: As part of an initiative to address quality of care and control healthcare costs, in 2002, the United States Centers for Medicare and Medicaid Services (CMS) defined "never events" as hospital-acquired conditions that were considered reasonably preventable 1 . In 2008, CMS added deep venous thrombosis (DVT) and pulmonary embolism (PE) following total knee arthroplasty (TKA) and total hip arthroplasty (THA) 2 .Historically, DVT and PE were important risks for patients undergoing TJA. In a study of 7,959 patients between 1962 and 1973, Charnley et al., reported a non-fatal PE rate of 7.89% and a 1.04% rate of fatal PE which constituted the highest single cause of death after a THA 3 . Coventry et al., identified a cohort of 2012 THA from 1969 to 1971 of which 58 did not receive chemoprophylaxis past post-operative day five and observed a DVT rate of 3.4%, a non-fatal PE rate of 5.2%, and a fatal PE rate of 3.4% 4,5 . In a series performed between 1990 and 1991, Warwick et al., identified 1,162 patients undergoing THA without routine chemoprophylaxis, with DVT confirmed by venography in 1.89% of patients and a PE rate of 1.20% with a subsequent mortality rate of 0.34% 6 .Early studies demonstrated a much higher incidence of VTE for TKA 7,8 . However, DVT in TKA patients occur distally in the calf which are less likely to progress into a PE which was observed at a rate of 1.3% 9 with fatalities of 0.19 to 0.4% 9,10 . Stulburg et al., examined a series of 638 patients from 1974 to 1979 among which 49 patients inadvertently did not receive prophylaxis; an impressive 83% of these patients developed a DVT 11 .In a prospective study with 34,397 consecutive and unselected THA or TKA procedures, 32 (0.09%) had a VTE after median two days despite ongoing thromboprophylaxis 12 . All surgery was done in a fast-track setup with accelerated mobilization and discharge. Another study has shown a 90-day incidence of 0.41% of VTE after unicompartmental knee arthroplasty 13 . All patients received thromboprophylaxis until discharge and were operated in a fast-track setup with a median length of stay of one day.With VTE as a common and potentially dangerous complication after TKA and THA, safe and effective strategies for prophylaxis were developed and studied. When warfarin dosage is titrated to an international normalized ratio (INR) of 1.5 to 2.0 and administered for approximately six weeks, DVT occurred at a rate of 0.2 to 1% with a non-fatal PE rate of 0.1 to 0.3% [14][15][16] . Warfarin was found to consistently decreased rates of VTE when utilized after THA or TKA, but may lead to a significant risk ...

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“…Over the past decade, optimization of perioperative pathways has made it possible for outpatient primary TJA to become a reality for appropriately selected patients [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ] In the future, multiple factors will present limitations on utilization of inpatient beds for orthopedic procedures including possible continuation of the COVID-19 pandemic, initiatives led by the Centers for Medicare and Medicaid Services to reduce lengths of stay and remove procedures from the inpatient-only list, and projected increases in the need for rTJA [ 27 , 28 ]. Consequently, it is prudent to develop perioperative pathways that allow for safe accelerated recovery and discharge following aseptic rTJA.…”

Section: Discussionmentioning

confidence: 99%

“…Outpatient primary TJA has been adopted at a growing number of ambulatory surgical centers (ASCs) and hospital systems in the United States. Studies have demonstrated that with appropriate risk stratification and patient selection, and modern arthroplasty care pathways and perioperative protocols, outpatient primary TJA has outcomes equivalent or superior to inpatient primary TJA [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ] More recently, early discharge following aseptic revision TJA has been investigated; however, only a few studies have been published to date, [ [21] , [22] , [23] , [24] ] with only 2 studies focused specifically on same-day discharge (SDD) [ 21 , 22 ]. As the trend toward outpatient primary and aseptic revision TJA accelerates, futher investigation is required to identify patient selection criteria and best perioperative practices to ensure patient safety.…”

Section: Introductionmentioning

confidence: 99%

Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience

Deans¹,

Buller²,

Ziemba-Davis³

et al. 2022

Arthroplasty Today

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Which Postoperative Day After Total Joint Arthroplasty Are Catastrophic Events Most Likely to Occur?

Cited by 10 publications

References 27 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

Recommendations from the ICM-VTE: Hip & Knee

Same-Day Discharge Following Aseptic Revision and Conversion Total Joint Arthroplasty: A Single-Institution Experience

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