Abstract
For patients who qualify, simultaneous bilateral total knee arthroplasty (TKA) is
a viable option for the treatment of bilateral symptoms. However, the incidence of
chronic obstructive pulmonary disease (COPD) has been steadily rising over the past
few decades and may impact those who qualify as candidates for bilateral TKA. As such,
the aim of this study was to determine the impact of COPD on postoperative outcomes
in patients who receive simultaneous bilateral TKA. A retrospective cohort study was
conducted utilizing data provided through the American College of Surgeons National
Surgical Quality Improvement Program. All patients who had undergone simultaneous
bilateral TKA between 2007 and 2016 were identified and further stratified into groups
based upon the COPD status. Incidence of adverse events after TKA in the acute postoperative
period was evaluated with univariate and multivariate analyses. COPD was found to
be an independent risk factor for the development of major (odds ratio [OR]: 2.5;
p = 0.015), renal (OR: 5.1; p = 0.02), and thromboembolic complications (OR: 2.5; p = 0.027). In addition, patients with COPD were at increased risk for having an extended
hospital length of stay (LOS; p < 0.001) and development of urinary tract infections (p < 0.001). Patients with COPD are at higher risk for development of overall major
complications, as well as renal and thromboembolic complications after simultaneous
bilateral TKA. Interestingly, patients were not at increased risk for the development
of pulmonary or wound complications. When considering a staged versus simultaneous
bilateral TKA, surgeons should be aware of the impact COPD status has on the postoperative
complication rate.
Keywords
simultaneous bilateral total knee arthroplasty - chronic obstructive pulmonary disease
- postoperative complications - length of stay - urinary tract infection
