학술논문
Improving Safety of Bilateral Knee Arthroplasty: Impact of Selection Criteria on Perioperative Outcome.
Document Type
Academic Journal
Author
Gerner P; Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.; Memtsoudis SG; Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.; Cozowicz C; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.; Stundner O; Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria.; Figgie M; Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.; Sculco TP; Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA.; Poultsides L; Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece; Centre of Orthopaedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece; Department of Orthopaedic Surgery, Division of Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA.
Source
Publisher: SAGE Country of Publication: United States NLM ID: 101273938 Publication Model: Print-Electronic Cited Medium: Print ISSN: 1556-3316 (Print) Linking ISSN: 15563316 NLM ISO Abbreviation: HSS J Subsets: PubMed not MEDLINE
Subject
Language
English
ISSN
1556-3316
Abstract
Background : Bilateral total knee arthroplasty (BTKA) procedures are associated with an increased risk of complications when compared with unilateral approaches. In 2006, in an attempt to reduce this risk, our institution implemented selection criteria that specified younger and healthier patients as candidates for BTKA. Questions/Purpose : We sought to investigate the effect of these selection criteria on perioperative outcomes. Methods : In a retrospective cohort study, we used institutional data to identify patients who underwent BTKA between 1998 and 2014. Patients were divided into 2 groups: those who underwent surgery before the 2006 introduction of our selection criteria (1998-2006) and those who underwent surgery after (2007-2014). Groups were compared in terms of demographics, comorbidity burden, and incidence of perioperative complications. Regression analysis was performed, calculating incidence rate ratios to evaluate changes in complication rates. Results : Before the selection criteria were implemented in 2006, patients who underwent BTKA were older and had a higher comorbidity burden. The rate of major complications per 1000 hospital days decreased from 31.5 in 1998 to 7.9 in 2014. A reduction in cardiac complications was the most significant contributor to this decrease in major complications. Conclusion : After stringent criteria for BTKA candidates were implemented at our institution, selection of younger patients with lower comorbidity burden was accompanied by a reduction in the incidence of operative complications. This suggests that introducing such criteria can be associated with a reduction in adverse perioperative outcomes.
Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Philipp Gerner, MD, Crispiana Cozowicz, MD, Ottokar Stundner, MD, and Lazaros Poultsides, MD, MSc, PhD, declare they have no conflicts of interest. Stavros G. Memtsoudis, MD, PhD, MBA, has relationships with Sandoz Inc, SGM Consulting, Centauros Healthcare Analytics and Consulting, Hath, and Parvizi Surgical Innovations, outside the submitted work. Thomas P. Sculco, MD, reports relationships with Lima and Exatech, outside the submitted work.
(© The Author(s) 2021.)
Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Philipp Gerner, MD, Crispiana Cozowicz, MD, Ottokar Stundner, MD, and Lazaros Poultsides, MD, MSc, PhD, declare they have no conflicts of interest. Stavros G. Memtsoudis, MD, PhD, MBA, has relationships with Sandoz Inc, SGM Consulting, Centauros Healthcare Analytics and Consulting, Hath, and Parvizi Surgical Innovations, outside the submitted work. Thomas P. Sculco, MD, reports relationships with Lima and Exatech, outside the submitted work.
(© The Author(s) 2021.)