title: Who Should Not Undergo Short Stay Hip and Knee Arthroplasty? Risk Factors Associated With Major Medical Complications Following Primary Total Joint Arthroplasty.
abstract: We retrospectively reviewed 1012 consecutive patients undergoing elective primary hip and knee arthroplasties to identify risk factors associated with postoperative complications. A total of 70 complications (6.9%) requiring additional physician interventions occurred following surgery and 59 (84%) occurred past 24 hours postoperatively. Independent multivariate risk factors for developing late (>24 hours) complications included COPD (adjusted OR 4.16), CHF (adjusted OR 9.71), CAD (adjusted OR 2.80), and cirrhosis (adjusted OR 8.43). These results suggest that most major medical complications requiring additional physician interventions occur greater than 24 hours following primary THA/TKA. Patients with history of COPD, CHF, CAD, and cirrhosis should not undergo short stay or outpatient TJA.
authors.affiliation: University of Pennsylvania, Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: P Maxwell
authors.initials: PM
authors.lastname: Courtney
authors.affiliation: University of Pennsylvania, Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joshua C
authors.initials: JC
authors.lastname: Rozell
authors.affiliation: University of Pennsylvania, Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Melnic
authors.affiliation: University of Pennsylvania, Department of Orthopaedic Surgery, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania; Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Gwo-Chin
authors.initials: GC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D000075202:Contraindications; D003324:Coronary Artery Disease / Q000150:complications; D005260:Female; D006333:Heart Failure / Q000150:complications; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: complications; risk factors; short stay/outpatient arthroplasty