The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes
Background: Total knee arthroplasty (TKA) procedures are expected to grow exponentially in the upcoming years, highlighting the importance of identifying preoperative risk factors that predispose patients to poor outcomes. The present study sought to determine if preoperative healthcare events (PHEs...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-10-01
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| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344123000845 |
| _version_ | 1797653936639836160 |
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| author | Emily M. Ronan, BA Thomas Bieganowski, MD Thomas H. Christensen, MD Joseph X. Robin, MD Ran Schwarzkopf, MD, MSc Joshua C. Rozell, MD |
| author_facet | Emily M. Ronan, BA Thomas Bieganowski, MD Thomas H. Christensen, MD Joseph X. Robin, MD Ran Schwarzkopf, MD, MSc Joshua C. Rozell, MD |
| author_sort | Emily M. Ronan, BA |
| collection | DOAJ |
| description | Background: Total knee arthroplasty (TKA) procedures are expected to grow exponentially in the upcoming years, highlighting the importance of identifying preoperative risk factors that predispose patients to poor outcomes. The present study sought to determine if preoperative healthcare events (PHEs) influenced outcomes following TKA. Methods: This was a retrospective review of all patients who underwent TKA at a single institution from June 2011 to April 2022. Patients who had a PHE within 90 days of surgery, defined as an emergency department visit or hospital admission, were compared to patients with no history of PHE. Patients who underwent revision, nonelective, and/or bilateral TKA were excluded. Chi-squared analysis and independent sample t-tests were used to determine significant differences between demographic variables. All significant covariates were included in binary logistic regressions used to predict discharge disposition, 90-day readmission, and 1-year revision. Results: Of the 10,869 patients who underwent TKA, 265 had ≥1 PHE. Patients who had a PHE were significantly more likely to require facility discharge (odds ratio [OR]: 1.662; P = .001) than patients who did not have a PHE. Any PHE predisposed patients to significantly higher 90-day readmission rates (OR: 2.173; P = .002). Patients with ≥2 PHEs were at a significantly higher risk of 1-year revision (OR: 5.870; P = .004) compared to patients without a PHE. Conclusions: Our results demonstrate that PHEs put patients at significantly greater risk of facility discharge, 90-day readmission, and 1-year revision. Moving forward, consideration of elective surgery scheduling in the context of a recent PHE may lead to improved postoperative outcomes. Level III Evidence: Retrospective Cohort Study. |
| first_indexed | 2024-03-11T16:52:05Z |
| format | Article |
| id | doaj.art-18d5e4e98e3f4ed99897f6025741d66b |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-03-11T16:52:05Z |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-18d5e4e98e3f4ed99897f6025741d66b2023-10-21T04:22:42ZengElsevierArthroplasty Today2352-34412023-10-0123101179The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative OutcomesEmily M. Ronan, BA0Thomas Bieganowski, MD1Thomas H. Christensen, MD2Joseph X. Robin, MD3Ran Schwarzkopf, MD, MSc4Joshua C. Rozell, MD5Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USADepartment of Orthopedic Surgery, NYU Langone Health, New York, NY, USACorresponding author. 301 East 17th Street, New York, NY 10003, USA. Tel.: +1 212 598 6000.; Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USABackground: Total knee arthroplasty (TKA) procedures are expected to grow exponentially in the upcoming years, highlighting the importance of identifying preoperative risk factors that predispose patients to poor outcomes. The present study sought to determine if preoperative healthcare events (PHEs) influenced outcomes following TKA. Methods: This was a retrospective review of all patients who underwent TKA at a single institution from June 2011 to April 2022. Patients who had a PHE within 90 days of surgery, defined as an emergency department visit or hospital admission, were compared to patients with no history of PHE. Patients who underwent revision, nonelective, and/or bilateral TKA were excluded. Chi-squared analysis and independent sample t-tests were used to determine significant differences between demographic variables. All significant covariates were included in binary logistic regressions used to predict discharge disposition, 90-day readmission, and 1-year revision. Results: Of the 10,869 patients who underwent TKA, 265 had ≥1 PHE. Patients who had a PHE were significantly more likely to require facility discharge (odds ratio [OR]: 1.662; P = .001) than patients who did not have a PHE. Any PHE predisposed patients to significantly higher 90-day readmission rates (OR: 2.173; P = .002). Patients with ≥2 PHEs were at a significantly higher risk of 1-year revision (OR: 5.870; P = .004) compared to patients without a PHE. Conclusions: Our results demonstrate that PHEs put patients at significantly greater risk of facility discharge, 90-day readmission, and 1-year revision. Moving forward, consideration of elective surgery scheduling in the context of a recent PHE may lead to improved postoperative outcomes. Level III Evidence: Retrospective Cohort Study.http://www.sciencedirect.com/science/article/pii/S2352344123000845Total knee arthroplastyOutcomesReadmissionRevisionPreoperative healthcare events |
| spellingShingle | Emily M. Ronan, BA Thomas Bieganowski, MD Thomas H. Christensen, MD Joseph X. Robin, MD Ran Schwarzkopf, MD, MSc Joshua C. Rozell, MD The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes Arthroplasty Today Total knee arthroplasty Outcomes Readmission Revision Preoperative healthcare events |
| title | The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes |
| title_full | The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes |
| title_fullStr | The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes |
| title_full_unstemmed | The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes |
| title_short | The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes |
| title_sort | impact of hospital exposures prior to total knee arthroplasty on postoperative outcomes |
| topic | Total knee arthroplasty Outcomes Readmission Revision Preoperative healthcare events |
| url | http://www.sciencedirect.com/science/article/pii/S2352344123000845 |
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