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Erschienen in:
01.01.2014 | Symposium: 2013 Knee Society Proceedings
Perioperative Morbidity and Mortality of Same-day Bilateral TKAs: Incidence and Risk Factors
Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 1/2014
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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.