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Akhtar M, Howell SM, Nedopil AJ, Hull ML. Similar Recovery Rate for Patients Aged between 50 and 89 Years That Go Home on the Surgery Day and Self-Administer Their Rehabilitation after Kinematically Aligned Total Knee Arthroplasty. J Pers Med 2024; 14:504. [PMID: 38793086 PMCID: PMC11122277 DOI: 10.3390/jpm14050504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND for kinematic alignment (KA) total knee arthroplasty (TKA), it was unknown whether 'the pace of recovery' at six weeks was different for patients with ages ranging between 50-59, 60-69, 70-79, and 80-89 years who were discharged on the surgery day and self-administered their rehabilitation. METHODS a single surgeon treated 206 consecutive patients with a KA-designed femoral component and an insert with a medial ball-in-socket, lateral flat articulation, and PCL retention. Each filled out preoperative and six-week Oxford Knee Score (OKS), Knee Society Score (KSS), Knee Function Score (KFS), and Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) questionnaires. The six-week minus preoperative value indicated improvement. RESULTS between age cohorts, the improvement was not different (p = 0.2319 to 0.9888). The mean improvement/six-week postoperative value was 6°/-2° for knee extension, 0°/119° for knee flexion, 7/31 for the OKS, 39/96 for the KSS, 7/64 for the KFS, and 13/62 for the KOOS. The 30-day hospital readmission rate was 1%. CONCLUSION surgeons who perform KA TKA can counsel 50 to 89-year-old patients that they can be safely discharged home on the surgery day with a low risk of readmission and can achieve better function at six weeks than preoperatively when performing exercises without a physical therapist.
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Affiliation(s)
- Muzammil Akhtar
- College of Medicine, California Northstate University, Elk Grove, CA 95757, USA
| | - Stephen M. Howell
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA; (S.M.H.); (M.L.H.)
| | - Alexander J. Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität, 97074 Würzburg, Germany;
| | - Maury L. Hull
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616, USA; (S.M.H.); (M.L.H.)
- Department of Orthopedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817, USA
- Department of Mechanical Engineering, University of California Davis, Davis, CA 95616, USA
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Teves J, Holc F, Castro Lalín A, García-Mansilla A, Vildoza S, R B, Carbó L, Costantini J. Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:128-133. [PMID: 37263578 DOI: 10.1016/j.recot.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/23/2023] [Accepted: 05/11/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty scores have not been standardized for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; P<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67, ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.
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Affiliation(s)
- J Teves
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F Holc
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Castro Lalín
- Departamento de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Vildoza
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Brandariz R
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Teves J, Holc F, Castro Lalín A, García-Mansilla A, Vildoza S, Brandariz R, Carbó L, Costantini J. [Translated article] Are frailty scores superior to the ASA score in predicting complications, hospital stay, and readmissions in total knee replacement? A comparative study between octogenarian and septuagenarian patients. Rev Esp Cir Ortop Traumatol (Engl Ed) 2024; 68:T128-T133. [PMID: 38000542 DOI: 10.1016/j.recot.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Frailty scores have not been standardised for the preoperative assessment of patients undergoing total knee replacement (TKR). The aim of this study was to compare the efficacy of the American Society of Anesthesiology (ASA) score, the Charlson comorbidity index (ICC) and the simple frailty score (SSF) in predicting complications, hospital stay, readmissions and mortality after elective TKR. MATERIALS AND METHODS We retrospectively studied 448 patients who underwent TKR for osteoarthritis at our institution between 2016 and 2019. They were divided into two groups: Group A (263 patients, <80 years) and Group B (185 patients, >80 years).). All were classified by ASA, ICC and SSF scores. RESULTS The ICC was higher in Group B (median 5 [RI: 4-6] vs. 4 [RI: 3-5]; p<.001); however, it was not associated with a higher number of complications. When performing a logistic regression analysis we found, for complications: OR SSF=0.67; ICC=1.11; ASA 3 & 4=0.89 and age=1.04; while for readmissions: OR SSF=2.09; ICC=1.01; ASA 3 & 4=0.79 and age=1. CONCLUSIONS The ICC and SSF scales showed no differences to the ASA scale in the prediction of readmissions, complications and hospital stay. However, the SSF seems to have a better correlation in predicting unplanned readmission.
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Affiliation(s)
- J Teves
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - F Holc
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A Castro Lalín
- Departamento de Anestesiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A García-Mansilla
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Vildoza
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - R Brandariz
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - L Carbó
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - J Costantini
- Departamento de Ortopedia, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Jensen CB, Troelsen A, Foss NB, Nielsen CS, Lindberg-Larsen M, Gromov K. Half of all hip and knee arthroplasty patients may be potential day-case candidates: a nationwide register study of 166,730 procedures. Acta Orthop 2024; 95:147-151. [PMID: 38393295 PMCID: PMC10886217 DOI: 10.2340/17453674.2024.40075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND PURPOSE The overall potential pool of day-case candidates on a national level in hip and knee arthroplasty is unknown. We aimed to estimate the proportion of hip and knee arthroplasty patients eligible for day-case surgery based on contemporary widely used criteria and determine whether there has been a change in the proportion of eligible patients over time and, secondarily, to investigate the proportion of eligible patients discharged on the day of surgery. METHODS Based on data from the Danish National Patient Register, we identified all patients undergoing primary unilateral hip or knee arthroplasty from January 2010 to March 2020. Using a modification of day-case eligibility criteria proposed by a national multicenter collaboration, we sorted patients into either day-case eligible or ineligible. A day-case procedure was defined as discharge on the day of surgery. RESULTS We included patients comprising a total of 166,730 primary total hip (THA), total knee (TKA), and unicompartmental knee arthroplasty (UKA). 48% (95% confidence interval [CI] 48-49) were eligible for day-case surgery, with a decline from 50% (CI 49-51) in 2010 to 46% (CI 46-47) eligible in 2019. More UKA patients were day-case eligible (55%, CI 54-56) than THA (47%, CI 47-48) and TKA patients (49%, CI 48-49). A maximum of 8.0% (CI 7.4-8.5) of eligible patients were discharged on the day of surgery in 2019. CONCLUSION 48% of the Danish hip and knee arthroplasty patients were potential day-case candidates, with a small decline in eligibility from 50% in 2010 to 46% in 2019. Day of surgery discharge among day-case eligible patients peaked at 8% in 2019. Thus, the potential for more day-case surgery seems large.
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Affiliation(s)
- Christian Bredgaard Jensen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre.
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre
| | - Nicolai Bang Foss
- Department of Anesthesiology, Copenhagen University Hospital Hvidovre, Hvidovre
| | - Christian Skovgaard Nielsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre
| | - Martin Lindberg-Larsen
- Department of Orthopaedic Surgery, Orthopaedic Research Unit (ORU), Odense University Hospital, Odense, Denmark
| | - Kirill Gromov
- Department of Orthopaedic Surgery, Clinical Orthopaedic Surgery Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Hvidovre
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Karimi AH, Grits D, Shah AK, Burkhart RJ, Kamath AF. Is Discharge Within a Day Following Total Hip Arthroplasty Safe in the Septuagenarian and Octogenarian Population? A Propensity-Matched Cohort Study. J Arthroplasty 2024; 39:13-18. [PMID: 37625466 DOI: 10.1016/j.arth.2023.08.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Limited data exists on whether patients older than 70 can safely be discharged within a day (rapid discharge (RD)) following primary total hip arthroplasty (THA). The purpose of this study was to compare perioperative complications and readmission rates associated with RD in patients ≥70 years compared to longer lengths of stay following THA. METHODS A retrospective, propensity-matched cohort study was conducted using the National Surgical Quality Improvement Program database from 2006 to 2020. Patients ≥70 years undergoing RD following THA were propensity matched to patients ≥70 years who had longer hospital stays (nonrapid discharge). Sub-analyses were performed for septuagenarians and octogenarians. Following 1:1 matching, multivariate analyses were performed to compare perioperative complications and readmissions. Following propensity matching, both groups contained 2,192 patients. RESULTS The RD patients were found to have shorter operative times (P < .001), less bleeding complications (P < .001), and were more likely to have home discharges (P < .001). The 2 cohorts did not differ in the remaining complications or 30-day postoperative period readmissions among all patients and when evaluating septuagenarians and octogenarians. CONCLUSION Patients ≥70 years undergoing RD following THA had comparable complication and readmission rates to patients older than 70 undergoing nonrapid discharge. Furthermore, RD patients were more likely to have home discharges and have shorter operations with less bleeding complications. Septuagenarians receiving RD were more likely to have an unplanned readmission. These data suggest that RD following THA can be performed safely in select patients older than 70.
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Affiliation(s)
- Amir H Karimi
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Grits
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aakash K Shah
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert J Burkhart
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Atul F Kamath
- Department of Orthopedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
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Amen TB, Song J, Mai E, Rudisill SS, Bovonratwet P, Subramanian T, Kaidi AK, Maayan O, Qureshi SA, Iyer S. Unplanned readmissions following ambulatory spine surgery: assessing common reasons and risk factors. Spine J 2023; 23:1848-1857. [PMID: 37716549 DOI: 10.1016/j.spinee.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND CONTEXT Although outpatient spine surgery is becoming increasingly popular in the United States, unplanned readmission following outpatient surgery remains a significant postoperative concern. PURPOSE This study aimed to (1) describe the incidence and timing of 30-day unplanned readmission after ambulatory lumbar and cervical spine surgery (2) evaluate the common reasons for readmission, and (3) identify factors associated with readmission in this population. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified in the National Surgical Quality Improvement Program (NSQIP) database. OUTCOME MEASURES Hospital readmission within 30 postoperative days. METHODS Patients who underwent ambulatory cervical or lumbar spine surgery between 2015 and 2020 were identified using the National Surgical Quality Improvement Program (NSQIP) database. Reasons for and timing of unplanned readmissions were recorded. Multivariable poisson regressions were employed to determine any independent predictors of readmission. RESULTS A total of 33,092 ambulatory cervical and 68,115 ambulatory lumbar spine surgery patients were identified. Incidences of 30-day readmission were 3.37% and 3.07% among cervical and lumbar patients, respectively. The most common surgical site-related reasons for readmission included uncontrolled pain, recurrence of disc herniation or major symptom, and postoperative hematoma/seroma. Common nonsurgical site-related reasons included gastrointestinal, neurological, and cardiovascular complications. Factors associated with readmission among cervical patients included age ≥55, BMI ≥35, functional dependence, diabetes, smoking, COPD, and steroid use, whereas factors associated with readmission following lumbar spine surgery included age ≥65, female sex, BMI ≥35, functional dependence, ASA ≥3, diabetes, smoking, COPD, and hypertension (p<.05 for all). CONCLUSION This study highlights the common reasons and factors associated with unplanned readmission following ambulatory spine surgery. Consideration of these factors may be critical to ensuring appropriate patient selection for ambulatory spine surgery.
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Affiliation(s)
- Troy B Amen
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA.
| | - Junho Song
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Eric Mai
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Samuel S Rudisill
- Rush Medical College, Rush University Medical Center, Chicago, IL, USA
| | - Patawut Bovonratwet
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Tejas Subramanian
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Austin K Kaidi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Omri Maayan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sheeraz A Qureshi
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
| | - Sravisht Iyer
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th St, New York, NY, USA
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