Analysis of the incidence and risk factors of blood transfusion in total knee revision: a retrospective nationwide inpatient sample database study
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SUBMITTER: Li X
PROVIDER: S-EPMC10953239 | biostudies-literature | 2024 Jan
REPOSITORIES: biostudies-literature
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Project description:IntroductionCommon postoperative complications of total knee arthroplasty (TKA) include blood transfusion. Although risk factors and incidence of blood transfusion have been studied through national databases, the relative impact of each risk factor needs to be synthesized over a longer time period into a new model need to be revised.Material and methodsPatient data were extracted from the National Inpatient Sample (NIS), which is the largest hospital care database in the US, and analyse patient data retrospectively from 2010 through 2019. The final data included the patients undergoing TKA. The final analysis assessed the demographics of patients, type of insurance, type of hospital, length of stay (LOS), preoperative comorbidities, total charge, inpatient mortality, medical-surgical postoperative complications.ResultsAfter extracting data from the NIS database, a total of 1,250,533 patients with TKA were included in the analysis, and the rate of transfusion was 6.60 %. TKA patients who receive blood transfusion had longer LOS (from 2-3 days to 3-4 days), more preoperative comorbidities, higher inpatient mortality rate, and increased total charge (P < 0.001). Moreover, postoperative complications associated with inpatients included sepsis, acute myocardial infarction and shock. Elective admission and private insurance were also regarded as protective factors.ConclusionBlood transfusion could bring postoperative complications to patients, which were also linked to health costs and risks. It was also a common preoperative comorbidities for older patients who underwent TKA. Through better blood management strategies, we could reduce patient transfusion rates and improve clinical outcomes.Level of Evidence: Diagnostic Level Ⅲ.
| S-EPMC11298927 | biostudies-literature
Project description:Perioperative blood loss leading to blood transfusion continues to be an issue for total knee arthroplasty (TKA) patients. The US Nationwide Inpatient Sample (NIS) was used to determine annual trends in allogenic blood transfusion rates, and effects of transfusion on in-hospital mortality, length of stay (LOS), costs, discharge disposition, and complications of primary TKA patients. TKA patients between 2000 and 2009 were included (n = 4,544,999) and categorized as: (1) those who received a transfusion of allogenic blood, and (2) those who did not. Transfusion rates increased from 7.7% to 12.2%. For both transfused and not transfused groups, mortality rates and mean LOS declined, while total costs increased. Transfused patients were associated with adjusted odds ratios of in-hospital mortality (AOR 1.16; P = 0.184), 0.71 ± 0.01 days longer LOS (P < 0.0001), and incurred ($1777 ± 36; P < 0.0001) higher total costs per admission.
| S-EPMC4254025 | biostudies-literature
Project description:BACKGROUND:Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors associated with delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. METHODS:A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who underwent primary elective THA were included. Patient demographics, preoperative comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. RESULTS:A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more preoperative comorbidities, longer LOS, extra hospital charges, and higher in-hospital mortality rate (P?<?0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Preoperative risk factors associated with postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. CONCLUSIONS:The results of our study identified a relatively low incidence of delirium after primary elective THA, which is as reported in the NIS and not necessarily the surgical population as a whole. Postoperative delirium of THA was associated with increased preoperative comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors associated with postoperative delirium to moderate its consequences.
| S-EPMC7329519 | biostudies-literature
Project description:BackgroundTo study the impact of valvular heart disease (VHD) on hip replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty.MethodsThis was a retrospective cohort study. Data on patients who had undergone hip replacement from 2005 to 2014 were extracted from the NIS database. Independent t test and chi-square test were used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time.ResultsVHD accounted for 5.56% and AS accounted for 0.03% of the patients before hip replacement surgeries. Patients with VHD before hip replacement are related to the following characteristics: female patients (odds ratio [OR] = 1.15 [1.12-1.18]), elective admission (OR = 0.78 [0.76-0.80]), Charlson Comorbidity Index ≥3 (OR = 1.06 [1.03-1.08]), large-volume hospitals (OR = 1.13 [1.1-1.2]), teaching hospitals (OR = 5 4.4 [2.9-6.7]), and hospital location in urban areas (OR = 1.22 [1.2-1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR = 2.96 [2.87-3.04]), acute pulmonary edema (OR = 1.13 [1.06-1.21]), acute cerebrovascular event (OR = 1.22 [1.16-1.74]), and acute renal failure (OR = 1.22 [1.17-1.27]). It also has an impact on DVT/PE (OR = 0.89 [0.8-0.99]). Patients with AS before hip replacement have basic demographic characteristics like those of hip replacement patients with valvular disease. Patients with AS are older than those without AS before surgery (OR = 3.28 [2.27-4.75) and are related to the following characteristics: female patients (OR = 1.92 [1.32-2.8]) and elective admission (OR = 0.51 [0.36-0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR = 2.50 [1.76-3.53]) and acute hepatic failure (OR = 7.69 [1.8-32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost.ConclusionVHD independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.
| S-EPMC8501620 | biostudies-literature
Project description:BackgroundWith the rising prevalence of abdominal radical hysterectomy, the need for perioperative blood transfusion has emerged as a significant clinical challenge. Independent risk factors for blood transfusion during abdominal radical hysterectomy remains limited, and identifying these factors is needed.MethodsA retrospective analysis of data was performed using the Nationwide Inpatient Sample (NIS), focusing on patients who underwent abdominal radical hysterectomy between 2010 and 2019. Patients were categorized into two groups based on whether they received a blood transfusion. The analysis encompassed various demographic factors, including race, sex, and age, as well as length of stay (LOS), total hospitalization charges, hospital characteristics (admission type, insurance type, bed size, teaching status, geographic location, and hospital region), hospital mortality rates, comorbidities, and perioperative complications. Subsequently, both univariate and multivariate logistic regression analyses were employed to ascertain factors associated with abdominal radical hysterectomy patients requiring blood transfusions.ResultsBlood transfusions occurred in 14.84% of patients between 2010 and 2019, with a downward trend over time. Receiving a transfusion was associated with several negative outcomes, including a longer length of stay, higher total charges, and complications like thrombocytopenia, acute myocardial infarction, pneumonia, and so on. Additionally, patients who received transfusions were more likely to experience postoperative delirium, deep vein thrombosis, and wound infection. Independent risk factors for blood transfusion include Black race, Asian or Pacific Islander race, non-elective surgery, hospitalization in a rural setting, pre-existing medical conditions like coagulopathy, chronic blood loss anemia, deficiency anemia and others. Conversely, patients with private insurance, residing in the West, or Midwest/North Central regions were less likely to require a blood transfusion.ConclusionOur study highlights the concern of perioperative blood transfusion in radical hysterectomy, linked to significant complications. Reducing intraoperative blood loss and optimizing care based on patient factors are crucial for improving outcomes.
| S-EPMC11600751 | biostudies-literature
Project description:BackgroundAs robot-assisted equipment is continuously being used in orthopaedic surgery, the past few decades have seen an increase in the usage of robotics for total knee arthroplasty (TKA). Thus, the purpose of the present study is to investigate the differences between robotic TKA and nonrobotic TKA on perioperative and postoperative complications and opioid consumption.MethodsAn administrative database was queried from 2010 to Q2 of 2017 for primary TKAs performed via robot-assisted surgery vs non-robot-assisted surgery. Systemic and joint complications and average morphine milligram equivalents were collected and compared with statistical analysis.ResultsPatients in the nonrobotic TKA cohort had higher levels of prosthetic revision at 1-year after discharge (P < .05) and higher levels of manipulation under anesthesia at 90 days and 1-year after discharge (P < .05). Furthermore, those in the nonrobotic TKA cohort had increased occurrences of deep vein thrombosis, altered mental status, pulmonary embolism, anemia, acute renal failure, cerebrovascular event, pneumonia, respiratory failure, and urinary tract infection during the inpatient hospital stay (all P < .05) and at 90 days after discharge (all P < .05). All of these categories remained statistically increased at the 90-days postdischarge date, except pneumonia and stroke. Patients in the nonrobotic TKA cohort had higher levels of average morphine milligram equivalents consumption at all time periods measured (P < .001).ConclusionsIn the present study, the use of robotics for TKA found lower revision rates, lower incidences of manipulation under anesthesia, decreased occurrence of systemic complications, and lower opiate consumption for postoperative pain management. Future studies should look to further examine the long-term outcomes for patients undergoing robot-assisted TKA.Level of evidenceLevel III.
| S-EPMC7772451 | biostudies-literature
Project description:BackgroundThe growing availability of electronic health records (EHRs) in the US could provide researchers with a more detailed and clinically relevant alternative to using claims-based data.MethodsIn this study we compared a very large EHR database (Health Facts©) to a well-established population estimate (Nationwide Inpatient Sample). Weighted comparisons were made using t-value and relative difference over diagnoses and procedures for the year 2010.ResultsThe two databases have a similar distribution pattern across all data elements, with 24 of 50 data elements being statistically similar between the two data sources. In general, differences that were found are consistent across diagnosis and procedures categories and were specific to the psychiatric-behavioral and obstetrics-gynecology services areas.ConclusionsLarge EHR databases have the potential to be a useful addition to health services researchers, although they require different analytic techniques compared to administrative databases; more research is needed to understand the differences.
| S-EPMC4572624 | biostudies-literature
Project description:BackgroundPostoperative pain (PP) is a dynamic process that reflects the complex interplay between symptoms, treatment, and patient experiences, and its intensity is reportedly primarily related to the severity of surgical trauma. However, no large-scale national database-based study has hitherto been conducted to assess the occurrence and features related to PP following breast cancer (BC) surgery.MethodsIn this retrospective analysis, we screened BC surgery cases between 2015 and 2019 within the National Inpatient Sample (NIS) Database, utilizing the International Classification of Diseases (ICD) 10th edition clinical modification codes. The researchers identified patients who developed PP and compared them to those who did not. Factors associated with PP were then screened: patient demographics (age and race), hospital characteristics (type of insurance, bed size, teaching status, type of admission, location, and hospital area), length of stay (LOS), total cost during hospitalization, inpatient mortality, comorbidities, and perioperative complications. Data were analyzed using descriptive statistics. Multivariate logistic regression analysis was used to determine the independent risk factors for postoperative pain in BC surgery.Results39,870 BC surgery cases were identified over a five-year period from 2015 to 2019. The overall occurrence of PP following breast cancer surgery was 6.15% (2,387 cases), with a slight upward trend every year. Significant racial disparities were observed, Whites associated with a higher incidence of PP (P < 0.001). In addition, the incidence of elective admission was 11.96% lower (67.491% vs. 79.451%) than that of patients without PP following breast cancer surgery (P < 0.001). Besides, PP was related to prolonged hospitalization duration (3 vs. 2 days; P < 0.001), and higher total cost ($68,283 vs. $60,036; P < 0.001). Multivariate logistic regression identified breast cancer surgery-independent risk factors for PP, including younger age, non-elective hospital admission, rural hospitals, depression, drug abuse, metastatic cancer, psychoses, weight loss, and chronic pulmonary disease. In addition, postoperative pain for BC was associated with urinary retention, gastrointestinal complications, continuous invasive ventilation, deep vein thrombosis, urinary tract infection, blood transfusion, arrhythmia, and chest pain.ConclusionDespite the low incidence of postoperative pain in BC surgery cases, it is essential to investigate factors predisposing to PP to allow optimal care management and improve the outcomes of this patient population.
| S-EPMC11520449 | biostudies-literature
Project description:BackgroundAfter release of the Comprehensive Care for Joint Replacement bundle, there has been increased emphasis on reducing readmission rates for total knee arthroplasty (TKA). The potential for a separate, clinically-relevant metric, TKA revision rates within a year following surgery, has not been fully explored. Based on this, we compared rates and payments for TKA readmission and revision procedures as metrics for improving quality and cost.MethodsWe utilized the 2013 Nationwide Readmission Database (NRD) to examine national readmission and revision rates, the reasons for revision procedures, and associated costs for elective TKA procedures. As data are not linked across years, we examined revision rates for TKA completed in the month of January by capturing revision procedures in the subsequent following 11-month period to approximate a 1-year revision rate. Diagnosis and procedure codes for revision procedures were collected. Average readmission and revision procedure costs were then calculated, and the cost distributed across the entire TKA population.ResultsWe identified 20,851 patients having TKA surgery. The mean unadjusted 30- and 90-day TKA readmission rates were 3.4% and 5.8%, respectively. In contrast, the mean unadjusted 3-month and approximate 1-year reoperation rates were 1.0% and 1.6%, respectively. The most common cause for revision was periprosthetic joint infection, which accounting for 62% of all reported revision procedures. The mean payment for 90-day readmission was roughly half ($10,589±$11,084) of the mean inpatient payment for single reoperation procedure at 90 days ($20,222±$17,799). Importantly, nearly half (46%) of all 90-day readmissions were associated with a reoperation event within the first year.ConclusionsReadmission following TKA is associated with a 1-year reoperation in approximately half of patients. These reoperations represent a significant patient burden and have a higher per episode cost. Early reoperation may represent a more clinically relevant target for quality improvement and cost containment.
| S-EPMC7327322 | biostudies-literature
Project description:BackgroundTotal knee arthroplasty (TKA) in patients with a prior contralateral above-knee amputation (AKA) is uncommon, with limited literature describing the outcomes. We used a national database to compare the outcomes of primary TKA in above-knee amputees and nonamputees.MethodsA retrospective review of TKA recipients with prior contralateral AKA was performed using the PearlDiver database from 2010 to Q2 of 2019. Subjects and outcomes were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revisions (ICD-9 and ICD-10). Patients were identified and matched at a 1-to-3 ratio with nonamputee (AKA group = 931; nonamputee group = 2792 patients). Perioperative outcomes and length of stay (LOS) were compared at 90 days, 6 months, 1 year, 3 years, and 5 years after TKA.ResultsThe AKA group had a longer LOS (5.19 vs 3.00, P < .001) and higher overall complications rate (33.8% vs 11.8%). At all studied time intervals, the AKA group had higher periprosthetic infections, revisions, mechanical complications, and respiratory failure (P < .001), as well as surgical site infection, pneumonia, and blood transfusion (P < .05).ConclusionOur study revealed higher overall complications and longer LOS among TKAs in prior contralateral above-knee amputees. Surgeons should evaluate the risks and benefits of performing a TKA on patients with prior contralateral AKA.
| S-EPMC8829440 | biostudies-literature