Impact of Charlson indices and comorbid conditions on complication risk in bilateral simultaneous total knee arthroplasty.
BACKGROUND
The purpose of this study was to evaluate the influence of Charlson indices and comorbid conditions on the risk of perioperative complications in bilateral simultaneous total knee arthroplasty (BSTKA).


METHODS
In our retrospective analysis, 556 patients including 133 males and 423 females (mean age 65.8years), who had undergone bilateral simultaneous total knee arthroplasty between 2011 and 2014 were included. Risk factors (Charlson comorbidity index (CCI), age-adjusted Charlson comorbidity index (ACCI), and comorbid illnesses) and perioperative complications were noted, and subsequently, statistical tests were applied.


RESULTS
There was significant association between Charlson indices and most of the complications (P<0.05) with high-risk ACCI groups (a score>5) bearing maximum odds for cumulative major complication (OR 4.165, P<0.001, 95% CI 1.874 to 9.256). In addition, hypertension, non-ischemic cardiac illness, and moderate to severe chronic kidney disease proved be to be determinants for major complications (P=0.031, P=0.041, and P=0.014, respectively). We also found significant associations between organ-specific illnesses and complications such as cardiac, pulmonary, neurological and renal complications (P<0.05).


CONCLUSIONS
Both CCI and ACCI are predictors of post-operative complications with ACCI being the better predictive determinant. Hence, these predictors should be used for risk stratification prior to patient selection for BSTKA. The influence of hypertension, non-ischemic cardiac illness and moderate to severe chronic kidney disease should also be considered during patient selection. Moreover, optimum organ function at the time of surgery should be a priority to avoid these complications.
Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India. Electronic address: sksmarya@yahoo.co.in.
S K S
SK
Marya
Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India. Electronic address: drpamit@gmail.com.
Priyadarshi
P
Amit
Department of Orthopaedics and Joint Replacement, Max Institute of Musculoskeletal Sciences, Saket, New Delhi, India. Electronic address: chandeep.singh@maxhealthcare.com.
Chandeep
C
Singh
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000601:surgery*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000150:complications* / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors
Bilateral simultaneous total knee arthroplasty; Charlson comorbidity index; Complications; Mortality; Risk factors