title: Unplanned admission to the intensive care unit after total hip arthroplasty.
abstract: Triage to the intensive care unit (ICU) after elective total hip arthroplasty proves a complex medical and resource decision point. A total of 1259 consecutive total hip arthroplasties were reviewed; 89 patients experienced unplanned ICU admissions. Significant risk factors for ICU admission in univariate analysis were age greater than 75 years, revision surgery, obstructive sleep apnea, creatinine clearance less than 60 mL/min, prior myocardial infarction, American Society of Anesthesiologist class 3 or greater, use of vasopressors intraoperatively, and body mass index greater than 35 kg/m(2). With multiple regression, age greater than 75 years (odds ratio [OR], 2.6 [1.2-5.6]), revision surgery (OR, 5.8 [3.0-11.4]), creatinine clearance less than 60 mL/min (OR, 6.5 [2.5-16.3]), prior myocardial infarction (OR, 7.2 [2.0-25.4]), and body mass index greater than 35 kg/m(2) (OR, 2.9 [1.4-6.2]) were predictive of unplanned ICU admission. With 1 risk factor, the risk of ICU admission was 40%, 2 (75%), 3 (93.5%), 4 (98.5%), and 5 (>99%). A prospective study of these risk factors is needed to establish a threshold for planned ICU admission.
authors.affiliation: Department of Orthopaedic Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Atul F
authors.initials: AF
authors.lastname: Kamath
authors.forename: Caitlin L
authors.initials: CL
authors.lastname: McAuliffe
authors.forename: Keith D
authors.initials: KD
authors.lastname: Baldwin
authors.forename: Jared B
authors.initials: JB
authors.lastname: Lucas
authors.forename: Laura M
authors.initials: LM
authors.lastname: Kosseim
authors.forename: Craig L
authors.initials: CL
authors.lastname: Israelite
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015992:Body Mass Index; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications
chemical_list: D003404:Creatinine