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J Knee Surg 2021; 34(07): 764-771
DOI: 10.1055/s-0039-3400539
Original Article

Aseptic Revision Total Knee Can Be Performed as Part of a Short-Stay Arthroplasty Program: An Analysis of the National Surgical Quality Improvement Program Database

Alex Gu 
1   George Washington School of Medicine and Health Sciences, Washington, District of Columbia
2   Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
,
Eleanor F. Gerhard
1   George Washington School of Medicine and Health Sciences, Washington, District of Columbia
,
Chapman Wei
1   George Washington School of Medicine and Health Sciences, Washington, District of Columbia
,
Patawut Bovonratwet
3   Yale School of Medicine, New Haven, Connecticut
,
Seth Stake
4   Department of Orthopedic Surgery, George Washington University Hospital, Washington, District of Columbia
,
Peter K. Sculco
2   Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, New York
,
Alexander S. McLawhorn
5   Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, New York
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Abstract

Total knee arthroplasty (TKA) is becoming an increasingly common procedure to alleviate knee pain often associated with osteoarthritis. As the number of revision TKAs performed continues to increase, there remains a debate regarding the efficacy of discharging patients earlier than the conventional 3 to 4 days in the postoperative period. A variety of studies have begun to show that interchangably discharge in the primary TKA setting has an economical benefit while causing either a reduction or no difference in patient outcomes. This study aims to determine the effect of rapid discharge at 0- to 2-day postoperative stay compared to the conventional 3- to 4-day postoperative stay on postdischarge complications in patients undergoing revision TKA. A retrospective cohort study was conducted using data collected through the American College of Surgeons National Quality Improvement Program Database. All patients who underwent aseptic revision TKA between 2005 and 2016 were identified and stratified into groups based on length of stay: 0 to 2 days versus 3 to 4 days. Patients suffering from predischarge complications were excluded to minimize bias. Single-component versus both-component revisions were analyzed. The incidence of adverse events following discharge was evaluated with univariate and logistic multivariate analyses where appropriate. Patients who underwent single-component revisions and were discharged rapidly were less likely to develop minor complications (p = 0.001; odds ratio [OR]: 0.355; 95% confidence interval [CI]: 0.188–0.671) and septic complications (p = 0.016; OR: 0.011; 95% CI: 0–0.430) within the 30-day postoperative period. No differences were observed in discharge cohorts among patients undergoing both-component revisions. We found that rapid discharge following aseptic revision TKA is not associated with increased risks for postoperative complications. Rapid discharge may have benefits for healthy patients undergoing single-component revisions. Careful selection of revision TKA patients for rapid discharge may help to lower the increasing costs of the procedure and improve patient outcomes. Further study is required to refine the selection criteria to identify patients eligible for short stay or outpatient revision TKA.

Keywords

knee - replacement - arthroplasty - postoperative - complications

Note

No benefits in any form have been received from a commercial party related directly or indirectly to the subject of this article.




Publication History

Received: 17 December 2018

Accepted: 14 October 2019

Article published online:
03 December 2019

© 2019. Thieme. All rights reserved.

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  • References

  • 1 McGrory BJ, Weber KL, Jevsevar DS, Sevarino K. Surgical management of osteoarthritis of the knee: evidence-based guideline. J Am Acad Orthop Surg 2016; 24 (08) e87-e93
    CrossrefPubMedGoogle Scholar
  • 2 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
    CrossrefPubMedGoogle Scholar
  • 3 Ferket BS, Feldman Z, Zhou J, Oei EH, Bierma-Zeinstra SM, Mazumdar M. Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative. BMJ 2017; 356: j1131
    CrossrefPubMedGoogle Scholar
  • 4 Agency for Healthcare Research and Quality. Healthcare Cost and Utilization Project. Accessed June 4, 2018 at: http://hcupnet.ahrq.gov/
    Google Scholar
  • 5 El Bitar YF, Illingworth KD, Scaife SL, Horberg JV, Saleh KJ. Hospital length of stay following primary total knee arthroplasty: data from the nationwide inpatient sample database. J Arthroplasty 2015; 30 (10) 1710-1715
    CrossrefPubMedGoogle Scholar
  • 6 Sutton III JC, Antoniou J, Epure LM, Huk OL, Zukor DJ, Bergeron SG. Hospital discharge within 2 days following total hip or knee arthroplasty does not increase major-complication and readmission rates. J Bone Joint Surg Am 2016; 98 (17) 1419-1428
    CrossrefPubMedGoogle Scholar
  • 7 Schairer WW, Vail TP, Bozic KJ. What are the rates and causes of hospital readmission after total knee arthroplasty?. Clin Orthop Relat Res 2014; 472 (01) 181-187
    CrossrefPubMedGoogle Scholar
  • 8 Trickey AW, Wright JM, Donovan J. et al. Interrated reliability of hospital readmission evaluations for surgical patients. Am J Med Qual 2017; 32 (02) 201-207
    CrossrefPubMedGoogle Scholar
  • 9 Whiting PS, Rice CD, Avilucea FR. et al. Patients at increased risk of major adverse events following operative treatment of distal radius fractures: inpatient versus outpatient. J Wrist Surg 2017; 6 (03) 220-226
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Rozell JC, Courtney PM, Dattilo JR, Wu CH, Lee GC. Late complications following elective primary total hip and knee arthroplasty: who, when, and how?. J Arthroplasty 2017; 32 (03) 719-723
    CrossrefPubMedGoogle Scholar
  • 11 Peterson J, Sodhi N, Khlopas A. et al. A comparison of relative value units in primary versus revision total knee arthroplasty. J Arthroplasty 2018; 33 (7S): S39-S42
    CrossrefPubMedGoogle Scholar
  • 12 Lovald ST, Ong KL, Malkani AL. et al. Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients. J Arthroplasty 2014; 29 (03) 510-515
    CrossrefPubMedGoogle Scholar