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Risk factors for early hospital readmission following total knee arthroplasty / Fatores de risco de reinternação hospitalar precoce após artroplastia total do joelho
Lehtonen, Eva J.; Hess, Matthew C.; McGwin Jr., Gerald; Shah, Ashish; Godoy-Santos, Alexandre Leme; Naranje, Sameer.
  • Lehtonen, Eva J.; University of Alabama. Department of Orthopedic Surgery. Birmingham. US
  • Hess, Matthew C.; University of Alabama. Department of Orthopedic Surgery. Birmingham. US
  • McGwin Jr., Gerald; University of Alabama. Department of Public Health. Birmingham. US
  • Shah, Ashish; University of Alabama. Department of Orthopedic Surgery. Birmingham. US
  • Godoy-Santos, Alexandre Leme; Universidade de Sao Paulo. Faculdade de Medicina. Hospital da Clinicas HCFMUSP. Sao Paulo. BR
  • Naranje, Sameer; University of Alabama. Department of Orthopedic Surgery. Birmingham. US
Acta ortop. bras ; 26(5): 309-313, Sept.-Oct. 2018. tab
Article in English | LILACS | ID: biblio-973575
ABSTRACT
ABSTRACT

Objective:

To identify independent risk factors, complications and early hospital readmission following total knee arthroplasty.

Methods:

Using the ACS-NSQIP database, we identified patients who underwent primary TKA from 2012-2015. The primary outcome was early hospital readmission. Patient demographics, preoperative comorbidities, laboratory data, operative characteristics, and postoperative complications were compared between readmitted and non-readmitted patients. Logistic regression identified independent risk factors for 30-day readmission.

Results:

137,209 patients underwent TKA; 3.4% were readmitted within 30 days. Advanced age, male sex, black ethnicity, morbid obesity, presence of preoperative comorbidities, high ASA classification, and increased operative time were independently related risk factors. Asian and no reported race were negative risk factors. Postoperative complications acute myocardial infarction, acute renal failure, stroke, pneumonia, pulmonary embolism, and deep vein thrombosis show positive associations.

Conclusions:

Advanced age, male sex, black ethnicity, morbid obesity, presence of comorbidities, high ASA classification and long operative time are independent risk factors for postoperative complications and early hospital readmission following total knee arthroplasty. Level of Evidence III, Case control study.
RESUMO
RESUMO

Objetivo:

Identificar fatores de risco independentes, complicações e reinternação precoce após artroplastia total do joelho.

Métodos:

A partir de banco de dados ACS-NSQIP, identificamos pacientes submetidos à ATJ primária de 2012 a 2015. O desfecho primário foi a reinternação hospitalar precoce. Dados demográficos, comorbidades pré-operatórias, dados laboratoriais, características cirúrgicas e complicações pós-operatórias foram comparadas entre os pacientes reinternados e não reinternados. A regressão logística identificou fatores de risco independentes para a reinternação em 30 dias.

Resultados:

Foram identificados 137.209 pacientes submetidos à ATJ, sendo que 3,4% foram reinternados no período de 30 dias. A idade avançada, o sexo masculino, a raça negra, a obesidade mórbida, a presença de comorbidades pré-operatórias, a alta classificação ASA e o aumento do tempo cirúrgico foram fatores de risco relacionados independentemente. A raça asiática e as não relatadas foram fatores de risco negativos. As complicações pós-operatórias infarto agudo do miocardio, insuficiência renal aguda, acidente vascular cerebral, pneumonia, embolia pulmonar e trombose venosa profunda apresentaram associações positivas.

Conclusões:

Idade avançada, sexo masculino, raça negra, obesidade mórbida, presença de comorbidades, classificação ASA elevada e tempo cirúrgico prolongado são fatores de risco independentes de complicações pós-operatórias e reinternação precoce após artroplastia total do joelho. Nível de evidência III, Estudo de caso de controle.


Full text: Available Index: LILACS (Americas) Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Acta ortop. bras Journal subject: Orthopedics Year: 2018 Type: Article Affiliation country: Brazil / United States Institution/Affiliation country: Universidade de Sao Paulo/BR / University of Alabama/US

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Full text: Available Index: LILACS (Americas) Type of study: Etiology study / Observational study / Prognostic study / Risk factors Language: English Journal: Acta ortop. bras Journal subject: Orthopedics Year: 2018 Type: Article Affiliation country: Brazil / United States Institution/Affiliation country: Universidade de Sao Paulo/BR / University of Alabama/US