Postoperative Morbidity and Mortality in Total Joint Arthroplasty: Exploring the Limits of Early Discharge

Overview

Journal J Clin Orthop Trauma

Specialty Orthopedics

Date 2021 Mar 15

PMID 33717890

Authors

Camilo Gutierrez Rodriguez

Maria Alejandra Asmar Murgas

Abelardo Camacho Uribe

Valeria Barrios Diaz

Guillermo Bonilla Leon

Adolfo Llinas Volpe

Affiliations

Soon will be listed here.

Abstract

Introduction: In order to enhance cost-effectiveness, shorter hospital stays have been adopted following hip or knee replacement surgery. This study seeks to describe the incidence of morbidity and mortality, five days after patients were taken to surgery with an expected hospital stay of four days.

Methods: Utilizing an Institutional Joint Replacement database, a descriptive study was carried out using a retrospective cohort of 1233 procedures in 1100 patients between 2012 and 2016. These were followed up for three months to evaluate morbidity and mortality in the postoperative period.

Results: Complications were classified as minor or major (these were defined as any adverse event that can threaten a patient's life or had the potential to result in readmission). Of the cohort, 18 (1.5%) patient procedures presented one or more major complications. On the first postoperative day 3 major complications occurred (including one death). On the second and third day, 4 major complications were registered each day. On the fourth day after surgery, there were no major complications. On the fifth day 1 major complication was identified. After patient discharge there were 6 major complications reported.

Discussion: The balance between early discharge and out-of-hospital morbidity as well as the frequency of hospital readmission must be the basis to determine whether a patient's hospital stay should be reduced. According to our results, it seems to be safe to shorten hospital stay in young and healthy patients. Furthermore, only orthopedic teams that have minimal rates of outpatient complications and adhere to high standards of care should consider reducing hospital stay.

References

Finch D, Martin B, Franklin P, Magder L, Pellegrini Jr V . Patient-Reported Outcomes Following Total Hip Arthroplasty: A Multicenter Comparison Based on Surgical Approaches. J Arthroplasty. 2020; 35(4):1029-1035.e3. PMC: 8218222. DOI: 10.1016/j.arth.2019.10.017. View

Zmistowski B, Restrepo C, Hess J, Adibi D, Cangoz S, Parvizi J . Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. J Bone Joint Surg Am. 2013; 95(20):1869-76. DOI: 10.2106/JBJS.L.00679. View

Slullitel P, Estefan M, Ramirez-Serrudo W, Comba F, Zanotti G, Piccaluga F . Re-admissions treble the risk of late mortality after primary total hip arthroplasty. Int Orthop. 2018; 42(9):2015-2023. DOI: 10.1007/s00264-018-3876-0. View

Nedza S, Fry D, DesHarnais S, Spencer E, Yep P . Emergency Department Visits Following Joint Replacement Surgery in an Era of Mandatory Bundled Payments. Acad Emerg Med. 2016; 24(2):236-245. DOI: 10.1111/acem.13080. View

Courtney P, Boniello A, Berger R . Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. J Arthroplasty. 2016; 32(5):1426-1430. DOI: 10.1016/j.arth.2016.11.055. View

Parvizi J, Mui A, Purtill J, Sharkey P, Hozack W, Rothman R . Total joint arthroplasty: When do fatal or near-fatal complications occur?. J Bone Joint Surg Am. 2007; 89(1):27-32. DOI: 10.2106/JBJS.E.01443. View

Masaracchio M, Hanney W, Liu X, Kolber M, Kirker K . Timing of rehabilitation on length of stay and cost in patients with hip or knee joint arthroplasty: A systematic review with meta-analysis. PLoS One. 2017; 12(6):e0178295. PMC: 5456061. DOI: 10.1371/journal.pone.0178295. View

Paredes O, Nunez R, Klaber I . Successful initial experience with a novel outpatient total hip arthroplasty program in a public health system in Chile. Int Orthop. 2018; 42(8):1783-1787. DOI: 10.1007/s00264-018-3870-6. View

Sweetland S, Green J, Liu B, Berrington de Gonzalez A, Canonico M, Reeves G . Duration and magnitude of the postoperative risk of venous thromboembolism in middle aged women: prospective cohort study. BMJ. 2009; 339:b4583. PMC: 2788913. DOI: 10.1136/bmj.b4583. View

10.

O Reilly M, Mohamed K, Foy D, Sheehan E . Educational impact of joint replacement school for patients undergoing total hip and knee arthroplasty: a prospective cohort study. Int Orthop. 2018; 42(12):2745-2754. DOI: 10.1007/s00264-018-4039-z. View

11.

Marsh J, Somerville L, Howard J, Lanting B . Significant cost savings and similar patient outcomes associated with early discharge following total knee arthroplasty. Can J Surg. 2018; 62(1):20-24. PMC: 6351266. DOI: 10.1503/cjs.002118. View

12.

Tay K, Tang A, Fary C, Patten S, Steele R, de Steiger R . The effect of surgical approach on early complications of total hip arthroplasty. Arthroplasty. 2022; 1(1):5. PMC: 8787926. DOI: 10.1186/s42836-019-0008-2. View

13.

Tulic G, Dubljanin-Raspopovic E, Tomanovic-Vujadinovic S, Sopta J, Todorovic A, Manojlovic R . Prolonged pre-operative hospital stay as a predictive factor for early outcomes and mortality after geriatric hip fracture surgery: a single institution open prospective cohort study. Int Orthop. 2017; 42(1):25-31. DOI: 10.1007/s00264-017-3643-7. View

14.

Schairer W, Sing D, Vail T, Bozic K . Causes and frequency of unplanned hospital readmission after total hip arthroplasty. Clin Orthop Relat Res. 2013; 472(2):464-70. PMC: 3890213. DOI: 10.1007/s11999-013-3121-5. View

15.

Yao D, Keswani A, Shah C, Sher A, Koenig K, Moucha C . Home Discharge After Primary Elective Total Joint Arthroplasty: Postdischarge Complication Timing and Risk Factor Analysis. J Arthroplasty. 2016; 32(2):375-380. DOI: 10.1016/j.arth.2016.08.004. View

16.

Kee J, Edwards P, Barnes C, Foster S, Mears S . After-Hours Calls in a Joint Replacement Practice. J Arthroplasty. 2019; 34(7):1303-1306. DOI: 10.1016/j.arth.2019.02.067. View

17.

Lizaur-Utrilla A, Gonzalez-Navarro B, Vizcaya-Moreno M, Miralles Munoz F, Gonzalez-Parreno S, Lopez-Prats F . Reasons for delaying surgery following hip fractures and its impact on one year mortality. Int Orthop. 2018; 43(2):441-448. DOI: 10.1007/s00264-018-3936-5. View

18.

Pulido L, Parvizi J, MacGibeny M, Sharkey P, Purtill J, Rothman R . In hospital complications after total joint arthroplasty. J Arthroplasty. 2008; 23(6 Suppl 1):139-45. DOI: 10.1016/j.arth.2008.05.011. View

19.

Kraus K, Buller L, Caccavallo P, Ziemba-Davis M, Meneghini R . Is There Benefit in Keeping Early Discharge Patients Overnight After Total Joint Arthroplasty?. J Arthroplasty. 2020; 36(1):24-29. PMC: 7364149. DOI: 10.1016/j.arth.2020.07.021. View

20.

Otero J, Gholson J, Pugely A, Gao Y, Bedard N, Callaghan J . Length of Hospitalization After Joint Arthroplasty: Does Early Discharge Affect Complications and Readmission Rates?. J Arthroplasty. 2016; 31(12):2714-2725. DOI: 10.1016/j.arth.2016.07.026. View