Dataset Information

Perioperative morbidity and mortality of same-day bilateral TKAs: incidence and risk factors.

ABSTRACT:

Background

Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified.

Questions/purposes

We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than 3 months apart (staged 3-12) at an institution where same-day bilateral TKAs were discouraged in patients with more severe medical comorbidities.

Methods

We analyzed institutional data from 3960 same-day, 172 staged 0-3, and 1533 staged 3-12 bilateral TKAs performed between 1998 and 2011. Patient demographics, comorbidities, and 30-day mortality were tabulated. Same-day patients were younger and healthier. Outcomes of interest included complications, blood transfusions, transfer to rehabilitation, and in-hospital charges. Regression models were conducted to identify independent risk factors for major morbidity or mortality.

Results

There were no differences in 30-day mortality among groups. The same-day group experienced more acute postoperative anemia, blood transfusions, and transfers to rehabilitation, but otherwise had complications comparable to those of the staged groups. In-hospital charges were lower in the same-day group. Congestive heart failure and pulmonary hypertension were the most significant factors associated with morbidity and mortality in the same-day group.

Conclusions

In a high-volume subspecialty setting in which patients undergoing same-day bilateral TKAs were generally much healthier and younger, we found that same-day bilateral TKAs appeared to be safe.

SUBMITTER: Poultsides L

PROVIDER: S-EPMC3889452 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Perioperative morbidity and mortality of same-day bilateral TKAs: incidence and risk factors.

Poultsides Lazaros L Memtsoudis Stavros S Gonzalez Della Valle Alejandro A De Martino Ivan I Do Huong T HT Alexiades Michael M Sculco Thomas T

Clinical orthopaedics and related research 20140101 1

<h4>Background</h4>Controversy persists regarding the safety of same-day bilateral TKAs, and indications for same-day versus staged bilateral surgery need to be clarified.<h4>Questions/purposes</h4>We compared the (1) 30-day mortality, (2) rates of in-hospital complications, (3) in-hospital charges, and (4) risk factors for complications among patients undergoing same-day and staged bilateral TKAs at two separate admissions within 1 year either less than 3 months apart (staged 0-3) or more than ...[more]

PMID: 23836245

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Project description:BackgroundThe recent series of reviews conducted within the Global Action Plan for Pneumonia and Diarrhoea (GAPPD) addressed epidemiology of the two deadly diseases at the global and regional level; it also estimated the effectiveness of interventions, barriers to achieving high coverage and the main implications for health policy. The aim of this paper is to provide the estimates of childhood pneumonia at the country level. This should allow national policy-makers and stakeholders to implement proposed policies in the World Health Organization (WHO) and UNICEF member countries.MethodsWE CONDUCTED A SERIES OF SYSTEMATIC REVIEWS TO UPDATE PREVIOUS ESTIMATES OF THE GLOBAL, REGIONAL AND NATIONAL BURDEN OF CHILDHOOD PNEUMONIA INCIDENCE, SEVERE MORBIDITY, MORTALITY, RISK FACTORS AND SPECIFIC CONTRIBUTIONS OF THE MOST COMMON PATHOGENS: Streptococcus pneumoniae (SP), Haemophilus influenzae type B (Hib), respiratory syncytial virus (RSV) and influenza virus (flu). We distributed the global and regional-level estimates of the number of cases, severe cases and deaths from childhood pneumonia in 2010-2011 by specific countries using an epidemiological model. The model was based on the prevalence of the five main risk factors for childhood pneumonia within countries (malnutrition, low birth weight, non-exclusive breastfeeding in the first four months, solid fuel use and crowding) and risk effect sizes estimated using meta-analysis.FindingsThe incidence of community-acquired childhood pneumonia in low- and middle-income countries (LMIC) in the year 2010, using World Health Organization's definition, was about 0.22 (interquartile range (IQR) 0.11-0.51) episodes per child-year (e/cy), with 11.5% (IQR 8.0-33.0%) of cases progressing to severe episodes. This is a reduction of nearly 25% over the past decade, which is consistent with observed reductions in the prevalence of risk factors for pneumonia throughout LMIC. At the level of pneumonia incidence, RSV is the most common pathogen, present in about 29% of all episodes, followed by influenza (17%). The contribution of different pathogens varies by pneumonia severity strata, with viral etiologies becoming relatively less important and most deaths in 2010 caused by the main bacterial agents - SP (33%) and Hib (16%), accounting for vaccine use against these two pathogens.ConclusionsIn comparison to 2000, the primary epidemiological evidence contributing to the models of childhood pneumonia burden has improved only slightly; all estimates have wide uncertainty bounds. Still, there is evidence of a decreasing trend for all measures of the burden over the period 2000-2010. The estimates of pneumonia incidence, severe morbidity, mortality and etiology, although each derived from different and independent data, are internally consistent - lending credibility to the new set of estimates. Pneumonia continues to be the leading cause of both morbidity and mortality for young children beyond the neonatal period and requires ongoing strategies and progress to reduce the burden further.

Dataset Information

Perioperative morbidity and mortality of same-day bilateral TKAs: incidence and risk factors.

Background

Questions/purposes

Methods

Results

Conclusions

Publications

Perioperative morbidity and mortality of same-day bilateral TKAs: incidence and risk factors.

Similar Datasets

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