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2010 Mid-America Orthopaedic Association Physician in Training Award: predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients

Carlos A Higuera, Karim Elsharkawy, Alison K Klika, Matthew Brocone, Wael K Barsoum
Clinical Orthopaedics and related Research 2011, 469 (5): 1391-400
21347818

BACKGROUND: Geriatric patients experience more adverse events owing to early complications after TKA or THA related to preexisting comorbidities. However, associations between patient and surgery variables, including age, BMI, and comorbidities with complications are unclear. Knowing these relationships is necessary for developing risk stratification, defining contraindications, and predicting complications and adverse outcomes.

QUESTIONS/PURPOSES: We wished to establish and quantify the associations among age, BMI, comorbidities, and type of surgery and anesthesia with complications and early adverse outcomes including longer length of stay, disposition to an extended care facility, readmission, and reoperation in geriatric patients undergoing TKA and THA.

PATIENTS AND METHODS: We prospectively followed a cohort of patients older than 65 years undergoing TKA or THA. Demographics, comorbidities, complications, discharge disposition, readmission, and/or reoperation information within the 90-day postoperative period were collected. Adjusted hierarchical stepwise multivariable regression models were used to analyze associations and relative risks with complications, length of stay, disposition, readmission, and reoperation rates.

RESULTS: Patients were approximately 40% more likely to have any complication per each subsequent 10 years of age. Patients who underwent bilateral TKAs were 65% more likely to have any type of complication. Patients who had epidural anesthesia were 2.6 times more likely to have a major systemic complication. Patients with coronary artery disease were more likely to have a transfusion, more likely to have major local complications, including joint infection and/or a major systemic complication, and more likely to require a reoperation after TKA.

CONCLUSIONS: Age, type of surgery, anesthesia, and other comorbidities, mainly coronary artery disease and chronic heart failure, were associated with complications and adverse outcomes. We believe these risk factors should be used to counsel patients and make preoperative surgical decisions.

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