Dataset Information

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty.

ABSTRACT:

Background

In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA.

Methods

A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 one-day length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conducted. Multiple logistic regression was used to evaluate predictors of SDD, as these patients represent those most likely to safely undergo TKA in an ASC.

Results

Controlling for other demographics and comorbidities, patients with the following characteristics were at reduced odds of SDD: increased age (odds ratio [OR] = 0.935, P < .001), body mass index ?35 (OR = 0.491, P = .002), female (OR = 0.535, P < .001), nonwhite race (OR = 0.456, P = .003), primary hypertension (OR = 0.710, P = .032), ?3 comorbidities (OR = 0.507, P = .002), American Society of Anesthesiologists score ?3 (OR = 0.378, P < .001). The model was deemed to be of adequate fit using the Hosmer and Lemeshow test (?² = 12.437, P = .112), and the area under the curve was found to be 0.773 indicating acceptable discrimination.

Conclusion

For patients undergoing primary TKA, increased age, body mass index ?35, female gender, nonwhite race, primary hypertension, ?3 comorbidities, and American Society of Anesthesiologists score ?3 decrease the likelihood of SDD. A predictive model based on readily available patient presentation and comorbidity characteristics may aid surgeons in identifying patients that are candidates for SDD or ASC-based TKA.

SUBMITTER: Turcotte JJ

PROVIDER: S-EPMC7856419 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty.

Turcotte Justin J JJ Menon Nandakumar N Kelly McKayla E ME Grover Jennifer J JJ King Paul J PJ MacDonald James H JH

Arthroplasty today 20210201

<h4>Background</h4>In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA.<h4>Methods</h4>A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.0%] and 2061 one-day length of stay [91.0%]) undergoing TKA at a regional medical center between July 2016 and September 2020 was conduct ...[more]

PMID: 33553547

Similar Datasets

Project description:Although total knee arthroplasty improves functional mobility in persons with end-stage knee osteoarthritis, many subjects have reported continued difficulty with stair ascent and descent after surgery. The purpose of the present study was to determine preoperative predictors of handrail use during stair ascent and descent following primary unilateral total knee arthroplasty.One hundred and five adults who were scheduled for unilateral total knee arthroplasty participated in the study. Postoperative handrail use during stair ascent or descent was predicted on the basis of preoperative functional measures. Preoperative age, body mass index, knee strength, knee flexion active range of motion, Knee Outcome Survey scores, time to complete a stair-climbing task, and previous handrail use were entered as covariates into a binary logistic regression. Forward logistic regression was performed to determine which preoperative factors best predicted handrail use at three months and two years after surgery. Handrail use in a control group was also evaluated at baseline and at the time of the two-year follow-up.Prior to surgery, sixty-three of the 105 subjects required a handrail. Two years after surgery, sixty of the 105 subjects required a handrail. In the control group, nineteen of the sixty-four subjects required a handrail at baseline and ten of thirty-one required a handrail at the time of the two-year follow-up. At two years, the preoperative ability to ascend and descend stairs without a handrail was the best predictor of individuals who would not require a handrail after surgery, followed by younger age and greater quadriceps strength. Collectively, these variables correctly predicted the ability of ninety of 105 persons to negotiate stairs without a handrail at two years after surgery (p < 0.001).Younger, stronger patients who do not use a handrail prior to unilateral total knee arthroplasty can expect the best outcomes in terms of ascending and descending stairs following surgery. This information may provide patients with more realistic expectations after surgery and allow them to make more appropriate discharge plans.

Dataset Information

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty.

Background

Methods

Results

Conclusion

Publications

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty.

Similar Datasets

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