Age, surgery type, coronary artery disease associated with complications after TKA

Type of surgery and anesthesia, age and coronary artery disease are all associated with complications and adverse outcomes following total knee and hip arthroplasty in geriatric patients, according to a study from researchers in Ohio.

“We all know that total hips and total knees are very successful operations, however, there is a high decrease in health-related quality of life after arthroplasty procedures — especially in the geriatric population,” Carlos A. Higuera, MD, said during his presentation at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. “This may be related with the worsening of pre-existing medical conditions, and postoperative complications most common within 90 days of the surgery. It is clear that optimization is needed, and this can be based on individualized care, defined contraindications and risk certification.”

Higuera’s team prospectively followed 502 geriatric patients who underwent 550 procedures — 304 total knee arthroplasties (TKAs), 48 bilateral procedures and 198 total hip arthroplasties. Data were collected on demographics, comorbidities, postoperative complications, surgical and hospitalization information, discharge disposition and readmission and/or reoperation within 90 days. These data were then analyzed to identify risk factors for complications.

“Age was a good predictor for length of stay,” Higuera said. “Bilateral total knees had a higher risk to go to a rehabilitation facility … I want you to pay special attention to coronary artery disease as a good predictor of readmission and reoperation.”

“In terms of complications, again — age, bilateral procedures and epidural procedures all have more complications,” he added.

According to Higuera, every 10 years of age made a patient twice as likely to have a major systemic complication.

Coronary artery disease, he added, was a serious factor.

“We found that coronary artery disease patients are 3.6 times more likely to have a complication, 2 times more likely to require readmission and 3 times more likely to require reoperation,” Higuera said. “We found these patients also had a higher rate of transfusion and a higher rate of joint infection.”

“Coronary artery disease, if I could leave you with a message, is for us the most important predictor for complication,” he added.

Reference:

• Higuera CA, Elsharkawy KA, Klika AK, et al. Predictors of early adverse outcomes in geriatric patients after total knee and hip arthroplasty. Paper #600. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 15-19. San Diego.

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