Dataset Information

Reintroduction of Hip and Knee Arthroplasty Through COVID-19 Pandemic: Experience at a High-Volume Hip and Knee Arthroplasty Centre in India.

ABSTRACT:

Background

COVID-19 was declared as a pandemic in March 2020. Government of India declared a countrywide lockdown on 24 March 2020. All elective surgeries including Hip and Knee arthroplasty were postponed in view of pandemic. Gradually cases were resumed after stepwise unlock measures. The aim of this study is to assess how hip and knee arthroplasty surgeries were affected during first wave of pandemic, and how situation was tackled by an arthroplasty unit of a tertiary-care hospital in India.

Methods

This study was a single-centre retrospective observational study. Data pertaining to patient demographic details, surgery, preoperative screening for COVID-19, duration of hospital stay, and post-op 30-day complications were collected from hospital records and analyzed. These data were compared with 2019 data.

Results

There was significant decrease (88.45%) in total number of hip and knee arthroplasty cases between March 2020 and November 2020 as compared to the same duration in 2019. 30-day mortality was only 2 deaths both who died due to COVID-19-related complications. Duration of stay in hospital and post-operative complications were not statistically and significantly affected. There was a statistically significant increase in tourniquet time compared to the previous year. If deaths due to COVID-19 are excluded, there was statistically no significance difference in 30-day mortality rate.

Conclusion

Following strict local policy for patient selection and reducing the number of post-operative patient visits to the hospital allowed us to perform hip and knee arthroplasty safely with minimum COVID-19-related mortality and morbidity.

Supplementary information

The online version contains supplementary material available at 10.1007/s43465-023-00930-6.

SUBMITTER: Sonawane CS

PROVIDER: S-EPMC10441840 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Reintroduction of Hip and Knee Arthroplasty Through COVID-19 Pandemic: Experience at a High-Volume Hip and Knee Arthroplasty Centre in India.

Sonawane Chandrashekhar S CS Kulkarni Mahesh M MM Wakankar Hemant M HM Rao Srisanat S SS

Indian journal of orthopaedics 20230721 9

<h4>Background</h4>COVID-19 was declared as a pandemic in March 2020. Government of India declared a countrywide lockdown on 24 March 2020. All elective surgeries including Hip and Knee arthroplasty were postponed in view of pandemic. Gradually cases were resumed after stepwise unlock measures. The aim of this study is to assess how hip and knee arthroplasty surgeries were affected during first wave of pandemic, and how situation was tackled by an arthroplasty unit of a tertiary-care hospital in ...[more]

PMID: 37609017

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Project description:ImportanceThe optimal pharmacologic thromboprophylaxis agent after total hip and total knee arthroplasty is uncertain and consensus is lacking. Quantifying the risk of postoperative venous thromboembolism (VTE) and bleeding and evaluating comparative effectiveness and safety of the thromboprophylaxis strategies can inform care.ObjectiveTo quantify risk factors for postoperative VTE and bleeding and compare patient outcomes among pharmacological thromboprophylaxis agents used after total hip and knee arthroplasty.Design, setting, and participantsThis retrospective cohort study used data from a large health care claims database. Participants included patients in the United States with hip or knee arthroplasty and continuous insurance enrollment 3 months prior to and following their surgical procedure. Patients were excluded if they received anticoagulation before surgery, received no postsurgical pharmacological thromboprophylaxis, or had multiple postsurgery thromboprophylactic agents. In a propensity-matched analysis, patients receiving a direct oral anticoagulant (DOAC) were matched with those receiving aspirin.ExposuresAspirin, apixaban, rivaroxaban, enoxaparin, or warfarin.Main outcomes and measuresThe primary outcome was 30-day cumulative incidence of postdischarge VTE. Other outcomes included postdischarge bleeding.ResultsAmong 29 264 patients included in the final cohort, 17 040 (58.2%) were female, 27 897 (95.2%) had inpatient admissions with median (IQR) length of stay of 2 (1-2) days, 10 948 (37.4%) underwent total hip arthroplasty, 18 316 (62.6%) underwent total knee arthroplasty; and median (IQR) age was 59 (55-63) years. At 30 days, cumulative incidence of VTE was 1.19% (95% CI, 1.06%-1.32%) and cumulative incidence of bleeding was 3.43% (95% CI, 3.22%-3.64%). In the multivariate analysis, leading risk factors associated with increased VTE risk included prior VTE history (odds ratio [OR], 5.94 [95% CI, 4.29-8.24]), a hereditary hypercoagulable state (OR, 2.64 [95% CI, 1.32-5.28]), knee arthroplasty (OR, 1.65 [95% CI, 1.29-2.10]), and male sex (OR, 1.34 [95% CI, 1.08-1.67]). In a propensity-matched cohort of 7844 DOAC-aspirin pairs, there was no significant difference in the risk of VTE in the first 30 days after the surgical procedure (OR, 1.14 [95% CI, 0.82-1.59]), but postoperative bleeding was more frequent in patients receiving DOACs (OR, 1.36 [95% CI, 1.13-1.62]).Conclusions and relevanceIn this cohort study of patients who underwent total hip or total knee arthroplasty, underlying patient risk factors, but not choice of aspirin or DOAC, were associated with postsurgical VTE. Postoperative bleeding rates were lower in patients prescribed aspirin. These results suggest that thromboprophylaxis strategies should be patient-centric and tailored to individual risk of thrombosis and bleeding.

Dataset Information

Reintroduction of Hip and Knee Arthroplasty Through COVID-19 Pandemic: Experience at a High-Volume Hip and Knee Arthroplasty Centre in India.

Background

Methods

Results

Conclusion

Supplementary information

Publications

Reintroduction of Hip and Knee Arthroplasty Through COVID-19 Pandemic: Experience at a High-Volume Hip and Knee Arthroplasty Centre in India.

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