title: Which patients need critical care intervention after total joint arthroplasty? : a prospective study of factors associated with the need for intensive care following surgery.
abstract: Older patients with multiple medical co-morbidities are increasingly being offered and undergoing total joint arthroplasty (TJA). These patients are more likely to require intensive care support, following surgery. We prospectively evaluated the need for intensive care admission and intervention in a consecutive series of 738 patients undergoing elective hip and knee arthroplasty procedures. The mean age was 60.6 years (18 to 91; 440 women, 298 men. Risk factors, correlating with the need for critical care intervention, according to published guidelines, were analysed to identify high-risk patients who would benefit from post-operative critical care monitoring. A total of 50 patients (6.7%) in our series required critical care level interventions during their hospital stay. Six independent multivariate clinical predictors were identified (p < 0.001) including a history of congestive heart failure (odds ratio (OR) 24.26, 95% confidence interval (CI) 9.51 to 61.91), estimated blood loss > 1000 mL (OR 17.36, 95% CI 5.36 to 56.19), chronic obstructive pulmonary disease (13.90, 95% CI 4.78 to 40.36), intra-operative use of vasopressors (OR 8.10, 95% CI 3.23 to 20.27), revision hip arthroplasty (OR 2.71, 95% CI 1.04 to 7.04) and body mass index > 35 kg/m(2) (OR 2.70, 95% CI 123 to 5.94). The model was then validated against an independent, previously published data set of 1594 consecutive patients. The use of this risk stratification model can be helpful in predicting which high-risk patients would benefit from a higher level of monitoring and care after elective TJA and aid hospitals in allocating precious critical care resources.
authors.affiliation: University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Courtney
authors.affiliation: University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Melnic
authors.affiliation: University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gutsche
authors.affiliation: University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.
authors.forename: E L
authors.initials: EL
authors.lastname: Hume
authors.affiliation: University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.
authors.forename: G-C
authors.initials: GC
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D015143:Philadelphia; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055815:Young Adult
keywords: complications; critical care; total hip arthroplasty; total knee arthroplasty