Abstract
The increasing number of patients undergoing total knee arthroplasty (TKA) has resulted
in efforts to better understand patient utilization of healthcare services in the
90-day postoperative period. The primary purpose of this study was to examine whether
emergency department (ED) visits in the year prior to elective TKA were predictive
of postoperative ED visits in the 90-day global period following surgery. A retrospective
chart review was performed for all patients undergoing TKA from June 1, 2011 to December
31, 2015 at a Veterans Affairs hospital. Total number of ED visits in the year prior
to surgery and 90 days following surgery were tabulated. Binary and ordinal logistic
regression analyses were utilized to determine if preoperative ED visits were predictive
of postoperative ED visits. The significance level was set to α = 0.05. Overall, 611
eligible TKA procedures were performed. The logistic regression model for postoperative
ED visits was significant (p < 0.001), with the number of preoperative ED visits (1 vs. 0: p < 0.001; 2 vs. 1: p = 0.012) and presence of diabetes (p = 0.007) both predicting the likelihood of a postoperative ED visit. Healthcare changes
that are redefining the concept of quality of care to include the postoperative care
episode, coupled with an increasingly aging population in need of TKA, will continue
to challenge orthopaedic surgeons to provide safe, competent, and cost-effective care
to patients. The results of this study demonstrate that a patient's propensity to
visit the ED prior to TKA is predictive of a tendency to do so postoperatively and
is of use to surgeons when evaluating and counselling patients who will be undergoing
a TKA.
Keywords total knee arthroplasty - emergency department visits - quality of care
