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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(03): 435-442
DOI: 10.1055/s-0042-1753534
Artigo Original
Joelho

Assessment of the Risk Factors Related to the Length of Hospital Stay and Postoperative Complications in Patients Undergoing Primary Total Knee Arthroplasty

Article in several languages: português | English
Filipe Marques de Oliveira 
1   Departamento de Ortopedia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Lauro Augusto Veloso Costa 
1   Departamento de Ortopedia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Angelo Mártyres Pedreira de Albuquerque Bastos 
1   Departamento de Ortopedia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Isabela Dias Paião 
1   Departamento de Ortopedia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Mário Ferretti 
1   Departamento de Ortopedia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
,
Mário Lenza 
1   Departamento de Ortopedia, Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Abstract

Objective To assess the risk factors involving longer hospital stays and early postoperative complications (first 30 days after surgery) in patients undergoing total knee arthroplasty (TKA).

Materials and Methods A cross-sectional study was conducted with collection of data of patients who underwent TKA in a private hospital between 2015 and 2019. The following data were collected: age, gender, body mass index, and clinical comorbidities. We also collected intraoperative data such as the grade on the classification of the American Society of Anesthesiologists (ASA), the duration of the surgery, the length of stay, the postoperative complications, and readmission within 30 days. Statistical models were used to investigate the possible risk factors associated with longer hospital stays and postoperative complications.

Results There was evidence of an increase in the length of hospital stay in older patients, with higher grades on the ASA classification or who suffered postoperative complications. For each increase in 1 year of age, we expect the length of stay to be multiplied by 1.008 (95% confidence interval [95%CI]: 1.004 to 1.012; p < 0,001). In patients who were ASA grade III, the time is expected to be multiplied by 1.297 (95%CI: 1.083 to 1.554; p = 0,005) when compared with grade-I patients. In patients who suffered postoperative complications, the time is expected to be multiplied by 1.505 (95%CI: 1.332 to 1.700; p < 0.001) compared with patients without complications.

Conclusion The present study demonstrated that, in patients who underwent primary TKA, preoperative characteristics such as older age and ASA grade ≥ III, as well as the development of postoperative complications, independently predict the increase in the length of hospital stay.

Keywords

arthroplasty, replacement, knee - outcome assessment - postoperative complications - length of stay

Financial Support

There was no financial support from public, commercial, or non-profit sources.


* Work developed at the Department of Orthopedics, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.




Publication History

Received: 11 April 2022

Accepted: 27 May 2022

Article published online:
26 September 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Lenza M, Ferraz SdeB, Viola DCM, Garcia Filho RJ, Cendoroglo Neto M, Ferretti M. Epidemiology of total hip and knee replacement: a cross-sectional study. Einstein (Sao Paulo) 2013; 11 (02) 197-202
    Google Scholar
  • 2 Ethgen O, Bruyère O, Richy F, Dardennes C, Reginster JY. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am 2004; 86 (05) 963-974
    Google Scholar
  • 3 Kane RL, Saleh KJ, Wilt TJ, Bershadsky B. The functional outcomes of total knee arthroplasty. J Bone Joint Surg Am 2005; 87 (08) 1719-1724
    Google Scholar
  • 4 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    Google Scholar
  • 5 Ferreira MC, Oliveira JCP, Zidan FF, Franciozi CEDS, Luzo MVM, Abdalla RJ. Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care. Rev Bras Ortop 2018; 53 (04) 432-440
    Google Scholar
  • 6 Memtsoudis SG, Della Valle AG, Besculides MC, Gaber L, Laskin R. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. J Arthroplasty 2009; 24 (04) 518-527
    Google Scholar
  • 7 Healy WL, Della Valle CJ, Iorio R. et al. Complications of total knee arthroplasty: standardized list and definitions of the Knee Society. Clin Orthop Relat Res 2013; 471 (01) 215-220
    Google Scholar
  • 8 Vonlanthen R, Slankamenac K, Breitenstein S. et al. The impact of complications on costs of major surgical procedures: a cost analysis of 1200 patients. Ann Surg 2011; 254 (06) 907-913
    Google Scholar
  • 9 Lagarde SM, Reitsma JB, Maris AK. et al. Preoperative prediction of the occurrence and severity of complications after esophagectomy for cancer with use of a nomogram. Ann Thorac Surg 2008; 85 (06) 1938-1945
    Google Scholar
  • 10 Konopka JF, Hansen VJ, Rubash HE, Freiberg AA. Risk assessment tools used to predict outcomes of total hip and total knee arthroplasty. Orthop Clin North Am 2015; 46 (03) 351-362
    Google Scholar
  • 11 Xie C, Li Q. A simple nomogram for predicting early complications in patients after primary knee arthroplasty. Knee 2020; 27 (02) 518-526
    Google Scholar
  • 12 Molloy IB, Martin BI, Moschetti WE, Jevsevar DS. Effects of the length of stay on the cost of total knee and total hip arthroplasty from 2002 to 2013. J Bone Joint Surg Am 2017; 99 (05) 402-407
    Google Scholar
  • 13 Wuerz TH, Kent DM, Malchau H, Rubash HE. A nomogram to predict major complications after hip and knee arthroplasty. J Arthroplasty 2014; 29 (07) 1457-1462
    Google Scholar
  • 14 Belmont Jr PJ, Goodman GP, Waterman BR, Bader JO, Schoenfeld AJ. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J Bone Joint Surg Am 2014; 96 (01) 20-26
    Google Scholar
  • 15 Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: When do fatal or near-fatal complications occur?. J Bone Joint Surg Am 2007; 89 (01) 27-32
    Google Scholar
  • 16 Marya SKS, Amit P, Singh C. Impact of Charlson indices and comorbid conditions on complication risk in bilateral simultaneous total knee arthroplasty. Knee 2016; 23 (06) 955-959
    Google Scholar
  • 17 Roger C, Debuyzer E, Dehl M. et al. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: Retrospective Cohort Study. Orthop Traumatol Surg Res 2019; 105 (05) 949-955
    Google Scholar
  • 18 Sarpong NO, Boddapati V, Herndon CL, Shah RP, Cooper HJ, Geller JA. Trends in length of stay and 30-day complications after total knee arthroplasty: an analysis from 2006 to 2016. J Arthroplasty 2019; 34 (08) 1575-1580
    Google Scholar
  • 19 Foni NO, Costa LAV, Paião ID. et al. Clinical pathway improves medical practice in total knee arthroplasty. PLoS One 2020; 15 (05) e0232881
    Google Scholar
  • 20 Johnson DJ, Castle JP, Hartwell MJ, D'Heurle AM, Manning DW. Risk factors for greater than 24-hour length of stay after primary total knee arthroplasty. J Arthroplasty 2020; 35 (03) 633-637
    Google Scholar
  • 21 Malik AT, Mufarrih SH, Ali A, Noordin S. Predictors of an increased length of stay following Total Knee Arthroplasty - Survey Report. J Pak Med Assoc 2019; 69 (08) 1159-1163
    Google Scholar
  • 22 Cleveland Clinic Orthopaedic Arthroplasty Group. The main predictors of length of stay after total knee arthroplasty: patient-related or procedure-related risk factors. J Bone Joint Surg Am 2019; 101 (12) 1093-1101
    Google Scholar
  • 23 March MK, Harmer AR, Dennis S. Does psychological health influence hospital length of stay following total knee arthroplasty? A systematic review. Arch Phys Med Rehabil 2018; 99 (12) 2583-2594
    Google Scholar
  • 24 Heo SM, Harris I, Naylor J, Lewin AM. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord 2020; 21 (01) 602
    Google Scholar
  • 25 Rhee C, Lethbridge L, Richardson G, Dunbar M. Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg 2018; 61 (03) 165-176
    Google Scholar
  • 26 Trivedi A, Ezomo OT, Gronbeck C, Harrington MA, Halawi MJ. Time Trends and risk factors for 30-day adverse events in black patients undergoing primary total knee arthroplasty. J Arthroplasty 2020; 35 (11) 3145-3149
    Google Scholar