Predictors of the need for critical care after total joint arthroplasty: an update of our institutional risk stratification model.
Based on our previously published risk stratification model, 295 (19%) of a consecutive series of 1594 TJA patients were triaged to the ICU. However, only 67 patients (22%) required intensive care interventions. We identified 5 independent multivariate predictors (P < 0.001) including COPD, CAD, CHF (1 point each), EBL > 1000 mL, and intraoperative vasopressors (2 points each) to form the Penn Arthroplasty Risk Score (PARS). Patients with a score of 0 through 7 had a probability of requiring critical care of 7.0%, 13.2%, 23.5%, 38.1%, 55.4%, 71.4%, 83.4%, and 91.1% respectively. Based on these results, our previous risk stratification protocol is overly sensitive and non-specific. Any risk stratification algorithm for ICU admission should include intraoperative risk factors in order to be fully predictive.
Department of Orthopaedic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
P Maxwell
PM
Courtney
Department of Orthopaedic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Colin M
CM
Whitaker
Department of Anesthesiology and Critical Care, University of Pennsylvania, Penn Presbyterian Medical Center, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Jacob T
JT
Gutsche
Department of Orthopaedic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Eric L
EL
Hume
Department of Orthopaedic Surgery, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Gwo-Chin
GC
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001178:Arthroplasty; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D019645:Arthroplasty, Replacement, Knee / Q000379:methods*; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012307:Risk Factors
complications; intensive care unit; risk stratification; total joint arthroplasty