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Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study

BACKGROUND: With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs....

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Autores principales: Kulshrestha, Vikas, Sood, Munish, Kumar, Santhosh, Sood, Nikhil, Kumar, Pradeep, Padhi, Prashanth P
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Orthopaedic Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858904/
https://www.ncbi.nlm.nih.gov/pubmed/35251542
http://dx.doi.org/10.4055/cios20234
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author Kulshrestha, Vikas
Sood, Munish
Kumar, Santhosh
Sood, Nikhil
Kumar, Pradeep
Padhi, Prashanth P
author_facet Kulshrestha, Vikas
Sood, Munish
Kumar, Santhosh
Sood, Nikhil
Kumar, Pradeep
Padhi, Prashanth P
author_sort Kulshrestha, Vikas
collection PubMed
description BACKGROUND: With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. METHODS: This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. RESULTS: TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). CONCLUSIONS: Screening and RM can reduce 90-day complications in patients undergoing TKA.
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spelling pubmed-88589042022-03-03 Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study Kulshrestha, Vikas Sood, Munish Kumar, Santhosh Sood, Nikhil Kumar, Pradeep Padhi, Prashanth P Clin Orthop Surg Original Article BACKGROUND: With ever-increasing demand for total knee arthroplasty (TKA), most healthcare systems around the world are concerned about its socioeconomic burden. Most centers have universally adopted well-defined clinical care pathways to minimize adverse outcomes, maximize volume, and limit costs. However, there are no prospective comparative trials reporting benefits of these risk mitigation (RM) strategies. METHODS: This is a prospective cohort study comparing post-TKA 90-day complications between patients undergoing RM before surgery and those following a standard protocol (SP). In the RM group, we used a 20-point checklist to screen for modifiable risk factors and evaluate the need for optimizing non-modifiable comorbidities. Only when optimization goals were achieved, patients were offered TKA. RESULTS: TKA was performed in 811 patients in the SP group and in 829 in the RM group, 40% of which were simultaneous bilateral TKA. In both groups, hypertension was the most prevalent comorbidity (48%), followed by diabetes (20%). A total of 43 (5.3%) procedure-related complications were seen over the 90-day postoperative period in the SP group, which was significantly greater than 26 (3.1%) seen in the RM group (p = 0.039). The commonest complication was pulmonary thromboembolic, 6 in each group. Blood transfusion rate was higher in the SP group (6%) than in the RM group (< 1%). CONCLUSIONS: Screening and RM can reduce 90-day complications in patients undergoing TKA. The Korean Orthopaedic Association 2022-03 2022-01-14 /pmc/articles/PMC8858904/ /pubmed/35251542 http://dx.doi.org/10.4055/cios20234 Text en Copyright © 2022 by The Korean Orthopaedic Association https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Kulshrestha, Vikas
Sood, Munish
Kumar, Santhosh
Sood, Nikhil
Kumar, Pradeep
Padhi, Prashanth P
Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study
title Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study
title_full Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study
title_fullStr Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study
title_full_unstemmed Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study
title_short Does Risk Mitigation Reduce 90-Day Complications in Patients Undergoing Total Knee Arthroplasty?: A Cohort Study
title_sort does risk mitigation reduce 90-day complications in patients undergoing total knee arthroplasty?: a cohort study
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8858904/
https://www.ncbi.nlm.nih.gov/pubmed/35251542
http://dx.doi.org/10.4055/cios20234
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