Abstract
Preoperative optimization and protocols for joint replacement care pathways have led
to decreased length of stay (LOS)and narcotic use, and are increasingly important
in delivering quality, cost savings, and shifting appropriate cases to an outpatient
setting. The intraoperative use of vasopressors is independently associated with increased
LOS and risk of adverse postoperative events including death, and in total hip arthroplasty,
there is an increased risk for intensive care unit (ICU) admission. Our aim is to
characterize the patient characteristics associated with vasopressor use specifically
in total knee arthroplasty (TKA). We retrospectively reviewed the electronic medical
records of a cohort of patients who underwent inpatient primary TKA at a single academic
hospital from January 1, 2017 to December 31, 2018. Demographics, comorbidities, perioperative
factors, and intraoperative medication administration were compared with multivariate
regression to identify patients who may require intraoperative vasopressors. Out of
these, 748 patients underwent TKA, 439 patients required intraoperative vasopressors,
while 307 did not. Significant independent predictors of vasopressor use were older
age (odds ratio [OR] = 1.06, 95% confidence interval [CI]: 1.03–1.08) and history
of a prior cerebrovascular accident (CVA; OR = 11.80, CI: 1.48–93.81). While not significant,
male sex (OR = 0.72, CI: 0.50–1.04) and regional anesthesia (OR = 0.64, CI: 0.40–1.05)
were nearing significance as negative independent predictors of vasopressor use. In
a secondary analysis, we did not observe an increase in complications attributable
to vasopressor administration intraoperatively. In conclusion, nearly 59% of patients
undergoing TKA received intraoperative vasopressor support. History of stroke and
older age were significantly associated with increased intraoperative vasopressor
use. As the first study to examine vasopressor usage in a TKA patient population,
we believe that understanding the association between patient characteristics and
intraoperative vasopressor support will help orthopaedic surgeons select the appropriate
surgical setting during preoperative optimization.
Keywords
intraoperative vasopressor - total knee arthroplasty - complications of TKA
