Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (4): 303-308.doi: 10.24920/003938
• Original Article • Previous Articles Next Articles
Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty
Lulu Ma1, Xuerong Yu1, *(
), Xisheng Weng2, Jin Lin2, Jin Jin2, Wenwei Qian2, Yuguang Huang1
- 1Department of Anesthesiology, Beijing 100730, China
2Department of Orthopedic Surgery;Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
-
Received:2021-05-21Accepted:2022-01-11Published:2022-12-31Online:2022-12-13 -
Contact:Xuerong Yu E-mail:yxr313@aliyun.com
Cite this article
Lulu Ma, Xuerong Yu, Xisheng Weng, Jin Lin, Jin Jin, Wenwei Qian, Yuguang Huang. Possible Risk Factors for Severe Complications Occurring after Primary Total Knee Arthroplasty[J].Chinese Medical Sciences Journal, 2022, 37(4): 303-308.
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Table 1.
Characteristics of in-hospital postoperative complications after total knee arthroplasty (n = 203)"
| Items | Number (%) |
|---|---|
| Grade | |
| Ⅰ | 58 (28.6) |
| Ⅱ | 72 (35.5) |
| Ⅲ | 63 (31.0) |
| Ⅳ | 9 (4.4) |
| Ⅴ | 1 (0.5) |
| Types | |
| Cardiac | 28 (13.7) |
| Pulmonary | 14 (6.9) |
| Neurologic | 11 (5.4) |
| Thromboembolic | 78 (38.2) |
| Wound or implant related | 49 (24.0) |
| Renal | 15 (7.4) |
| Gastrointestinal | 6 (2.9) |
| Others | 16 (7.8) |
Table 1.
Table 2.
Comparisons of preoperative parameters between patients who had severe complications and those who did not"
| Items | Total (n=2,974) | Severe complication group (n=73) | Non-severe complication group (n=2,901) | χ2 or t value | P value |
|---|---|---|---|---|---|
| Age (yrs, mean±SD) | 66.5±9.0 | 67.8±8.9 | 66.4±9.0 | 0.670 | 0.210 |
| >75 years old [n (%)] | 515 (17.3) | 22 (30.6) | 493 (17.0) | 8.475 | 0.007 |
| Sex [n (%)] | 10.922 | 0.002 | |||
| Female | 2,403 (80.8) | 48 (65.8) | 2,355 (81.2) | ||
| Male | 571 (19.2) | 25 (34.2) | 546 (18.8) | ||
| BMI (kg/m2, mean±SD) | 26.8±3.7 | 27.0±4.2 | 26.8±3.7 | 1.877 | 0.657 |
| ASA [n (%)] | 4.239 | 0.375 | |||
| Ⅰ | 571 (19.2) | 9 (12.3) | 562 (19.4) | ||
| Ⅱ | 2,178 (73.2) | 55 (75.3) | 2,123 (73.2) | ||
| Ⅲ | 225 (7.6) | 9 (12.3) | 216 (7.4) | ||
| NYHA [n (%)] | 3.143 | 0.370 | |||
| Ⅰ | 1,333 (44.8) | 26 (35.6) | 1,307 (45.1) | ||
| Ⅱ | 1,596 (53.7) | 45 (61.6) | 1,551 (53.5) | ||
| Ⅲ | 45 (1.5) | 2 (2.7) | 43 (1.5) | ||
| Comorbidity disease [n (%)] | |||||
| Hypertension | 1,683 (56.6) | 40 (54.8) | 1,643 (56.6) | 0.098 | 0.811 |
| Coronary artery disease | 353 (11.9) | 7 (9.6) | 346 (11.9) | 0.372 | 0.713 |
| Arrythmia | 120 (4) | 8 (11.1) | 112 (3.9) | 9.265 | 0.008 |
| Cerebrovascular disease | 168 (5.6) | 11 (15.1) | 157 (5.4) | 12.944 | 0.002 |
| Chronic kidney disease | 152 (5.1) | 5 (6.8) | 147 (5.1) | 0.466 | 0.421 |
| Diabetes mellitus | 556 (18.7) | 15 (20.5) | 541 (18.6) | 0.168 | 0.650 |
| COPD | 56 (1.9) | 1 (1.4) | 55 (1.9) | 0.107 | 1.000 |
| Smoking [n (%)] | 54 (1.8) | 1 (1.4) | 53 (1.8) | 0.903 | 1.000 |
| Diagnosis [n (%)] | 0.134 | 0.645 | |||
| Osteoarthritis | 2,762 (92.9) | 67 (91.8) | 2,695 (92.9) | ||
| Others | 212 (7.1) | 6 (8.2) | 206 (7.1) |
Table 2.
Table 3.
Comparisons of intra- and postoperative parameters between the patients with and without severe complications"
| Items | Total (n=2,974) | Severe complication group (n=73) | Non-severe complication group (n=2,901) | χ2 or t value | P value |
|---|---|---|---|---|---|
| Type of anesthesia [n (%)] | 0.186 | 0.911 | |||
| General anesthesia | 2,812 (94.6) | 69 (94.5) | 2,743 (94.6) | ||
| Spinal or spinal combined with epidural | 155 (5.2) | 4 (5.5) | 151 (5.2) | ||
| Conversion to general anesthesia | 7 (0.2) | 0 | 7 (0.2) | ||
| Type of surgery [n (%)] | 0.013 | 0.901 | |||
| Unilateral total knee arthroplasty | 1,974 (66.4) | 48 (65.8) | 1,926 (66.4) | ||
| Bilateral total knee arthroplasty | 1,000 (33.6) | 25 (34.2) | 975 (33.6) | ||
| Length of anesthesia (min, mean±SD) | 163.1±59.1 | 164.4±57.7 | 163.1±59.1 | 0.002 | 0.840 |
| Length of operation (min, mean±SD) | 124.2±55.1 | 125.6±55.6 | 124.1±55.1 | 0.084 | 0.803 |
| Length of tourniquet application (min, mean±SD) | 104.1±49.2 | 103.6±52.9 | 104.1±49.1 | 0.664 | 0.912 |
| Preoperative hemoglobin (g/L, mean±SD) | 132.4±24.8 | 132.6±12.9 | 132.4±25.0 | 0.001 | 0.928 |
| Preoperative anemia [n (%)] | 474 (15.9) | 11 (15.1) | 463 (16.0) | 0.042 | 1.000 |
| Perioperative transfusion [n (%)] | 309 (10.4) | 16 (21.9) | 293 (10.1) | 10.682 | 0.003 |
| Length of hospital stay [d, median (range)] | 7 (4, 9) | 14 (8.5, 18.5) | 6 (4, 8) | 125.211 | <0.001 |
| ICU admission post-operatively [n (%)] | 30 (1.0) | 9 (12.3) | 21 (0.7) | 96.036 | <0.001 |
Table 3.
Table 4.
Binary Logistic regression analysis of predictive risk factors for severe complications after total knee arthroplasty"
| Variables | B | Standard error | Wald χ2 | P value | OR | 95%CI |
|---|---|---|---|---|---|---|
| Male | 0.779 | 0.254 | 9.383 | 0.002 | 2.178 | 1.324-3.585 |
| ≥75 years old | 0.661 | 0.263 | 6.286 | 0.012 | 1.936 | 1.155-3.244 |
| Arrhythmia | 1.069 | 0.392 | 7.430 | 0.006 | 2.913 | 1.350-6.285 |
| Cerebrovascular diseases | 1.031 | 0.343 | 9.048 | 0.003 | 2.804 | 1.432-5.489 |
Table 4.
| [1] |
Memtsoudis SG, Della Valle AG, Besculides MC, et al. Trends in demographics, comorbidity profiles, in-hospital complications and mortality associated with primary knee arthroplasty. J Arthroplasty 2009; 24(4):518-27. doi: 10.1016/j.arth.2008.01.307.
doi: 10.1016/j.arth.2008.01.307 pmid: 18534410 |
| [2] |
Deng QF, Gu HY, Peng WY, et al. Impact of enhanced recovery after surgery on postoperative recovery after joint arthroplasty: results from a systematic review and meta-analysis. Postgrad Med J 2018; 94(1118):678-93. doi: 10.1136/postgradmedj-2018-136166.
doi: 10.1136/postgradmedj-2018-136166 |
| [3] |
Pitter FT, Jørgensen CC, Lindberg-Larsen M, et al. Postoperative morbidity and discharge destinations after fast-track hip and knee arthroplasty in patients older than 85 years. Anesth Analg 2016; 122(6):1807-15. doi: 10.1213/ANE.0000000000001190.
doi: 10.1213/ANE.0000000000001190 pmid: 27195631 |
| [4] |
Mundi R, Axelrod DE, Najafabadi BT, et al. Early discharge after total hip and knee arthroplasty—an observational cohort study evaluating safety in 330,000 patients. J Arthroplasty 2020; 35(12):3482-7.e3. doi: 10.1016/j.arth.2020.06.092
doi: 10.1016/j.arth.2020.06.092 |
| [5] |
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae.
doi: 10.1097/01.sla.0000133083.54934.ae pmid: 15273542 |
| [6] |
Okabe H, Ohsaki T, Ogawa K, et al. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg 2019; 217(4):677-81. doi: 10.1016/j.amjsurg.2018.07.009.
doi: S0002-9610(18)30655-X pmid: 30473227 |
| [7] |
Agha R, Abdall-Razak A, Crossley E, et al. STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 2019; 72:156-65. doi: 10.1016/j.ijsu.2019.11.002.
doi: S1743-9191(19)30309-7 pmid: 31704426 |
| [8] |
Sutton JC 3rd, Antoniou J, Epure LM, et al. 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):1419-28. doi: 10.2106/JBJS.15.01109.
doi: 10.2106/JBJS.15.01109 pmid: 27605685 |
| [9] |
Lipska MA, Bissett IP, Parry BR, et al. Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 2006; 76(7):579-85. doi: 10.1111/j.1445-2197.2006.03780.x.
doi: 10.1111/j.1445-2197.2006.03780.x pmid: 16813622 |
| [10] |
Kirchhoff P, Dincler S, Buchmann P. A multivariate analysis of potential risk factors for intra- and postoperative complications in 1316 elective laparoscopic colorectal procedures. Ann Surg 2008; 248(2):259-65. doi: 10.1097/SLA.0b013e31817bbe3a.
doi: 10.1097/SLA.0b013e31817bbe3a pmid: 18650636 |
| [11] |
Kang SC, Kim HI, Kim MG. Low serum albumin level, male sex, and total gastrectomy are risk factors of severe postoperative complications in elderly gastric cancer patients. J Gastric Cancer 2016; 16(1):43-50. doi: 10.5230/jgc.2016.16.1.43.
doi: 10.5230/jgc.2016.16.1.43 pmid: 27104026 |
| [12] |
Ross TD, Dvorani E, Saskin R, et al. Temporal trends and predictors of thirty-day Readmissions and Emergency Department visits following total knee arthroplasty in Ontario between 2003 and 2016. J Arthroplasty 2020;35(2):364-70. doi: 10.1016/j.arth.2019.09.015
doi: 10.1016/j.arth.2019.09.015 |
| [13] |
Berstock JR, Beswick AD, Lenguerrand E, et al. Mortality after total hip replacement surgery: a systematic review. Bone Joint Res 2014; 3(6):175-82. doi: 10.1302/2046-3758.36.2000239.
doi: 10.1302/2046-3758.36.2000239 pmid: 24894596 |
| [14] |
Lie SA, Pratt N, Ryan P, et al. Duration of the increase in early postoperative mortality after elective hip and knee replacement. J Bone Joint Surg Am 2010; 92(1):58-63. doi: 10.2106/JBJS.H.01882.
doi: 10.2106/JBJS.H.01882 pmid: 20048096 |
| [15] |
Hunt LP, Ben-Shlomo Y, Clark EM, et al. 45-day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 2014; 384 (9952):1429-36. doi: 10.1016/S0140-6736(14)60540-7.
doi: 10.1016/S0140-6736(14)60540-7 pmid: 25012118 |
| [16] |
Cleveland Clinic Orthopaedic Arthroplasty Group. The main predictors of length of stay after total knee arthroplasty: patient-related or procedure-related risk factors. J Bone Joint Surg Am 2019 ;101(12):1093-101. doi: 10.2106/JBJS.18.00758.
doi: 10.2106/JBJS.18.00758 |
| [17] |
Lu Y, Zhou ZY, Liu YK, et al. Gender differences of venous thromboembolism risk after total hip and total knee arthroplasty: a meta-analysis. J Thromb Thrombolysis 2016; 41(4):556-62. doi: 10.1007/s11239-015-1283-6.
doi: 10.1007/s11239-015-1283-6 |
| [18] |
Chen AZ, Gu A, Chen FR, et al. Biological sex has no impact on postoperative complications following simultaneous bilateral total knee arthroplasty. J Orthop 2019; 17:49-52. doi: 10.1016/j.jor.2019.06.013.
doi: 10.1016/j.jor.2019.06.013 |
| [19] |
Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA 2014; 311(20):2110-20. doi: 10.1001/jama.2014.4573.
doi: 10.1001/jama.2014.4573 pmid: 24867014 |
| [20] |
Jensen CB, Troelsen A, Petersen PB, et al. Influence of body mass index and age on day-of-surgery discharge, prolonged admission, and 90-day readmission after fast-track unicompartmental knee arthroplasty. Acta Orthop 2021; 92(6):722-7. doi: 10.1080/17453674.2021.1968727.
doi: 10.1080/17453674.2021.1968727 |
| [21] |
Rozell JC, Courtney PM, Dattilo JR, et al. Late complications following elective primary total hip and knee arthroplasty: who, when, and how? J Arthroplasty 2017; 32(3):719-23. doi: 10.1016/j.arth.2016.08.037.
doi: S0883-5403(16)30584-8 pmid: 27682005 |
| [22] |
Courtney PM, Rozell JC, Melnic CM, et al. Who should not undergo short stay hip and knee arthroplasty? Risk factors associated with major medical complications following primary total joint arthroplasty. J Arthroplasty 2015; 30(9 Suppl):1-4. doi: 10.1016/j.arth.2015.01.056.
doi: 10.1016/j.arth.2015.01.056 |
| [23] |
Tang H, Li H, Zhang S, et al. Postoperative complications causing readmission in 30 days after total knee arthroplasty: a retrospective nested case-control study of risk factors based on propensity score matching. J Knee Surg 2020; 33(11):1100-8. doi: 10.1055/s-0039-1692630.
doi: 10.1055/s-0039-1692630 |
| [24] |
Heo SM, Harris I, Naylor J, et al. Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry. BMC Musculoskelet Disord 2020; 21(1):602. doi: 10.1186/s12891-020-03612-8.
doi: 10.1186/s12891-020-03612-8 |
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