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Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors

  • Symposium: 2013 Knee Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified.

Questions/purposes

We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0–3) or more than 3 months apart (staged 3–12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities.

Methods

We analyzed institutional data from 3960 same-day, 172 staged 0–3, and 1533 staged 3–12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Same-day patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality.

Results

There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group.

Conclusions

In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that same-day bilateral TKAs appeared to be safe.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Andres Gleich MBA, Christopher Ferrandina BA, and David Staum BA for their expertise with the data collection and management.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Lazaros Poultsides MD, Alejandro Gonzalez Della Valle MD, Ivan De Martino MD, Michael Alexiades MD & Thomas Sculco MD

  2. Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA

    Stavros Memtsoudis MD

  3. Epidemiology and Biostatistics Core, Hospital for Special Surgery, New York, NY, USA

    Huong T. Do MA

Authors
  1. Lazaros Poultsides MD
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  2. Stavros Memtsoudis MD
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  3. Alejandro Gonzalez Della Valle MD
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  4. Ivan De Martino MD
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  5. Huong T. Do MA
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  6. Michael Alexiades MD
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  7. Thomas Sculco MD
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Corresponding author

Correspondence to Lazaros Poultsides MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Poultsides, L., Memtsoudis, S., Gonzalez Della Valle, A. et al. Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors. Clin Orthop Relat Res 472, 111–120 (2014). https://doi.org/10.1007/s11999-013-3156-7

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  • DOI: https://doi.org/10.1007/s11999-013-3156-7

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