Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
HSS Journal ®
Published in: HSS Journal ® 1/2016

01-02-2016 | Original Article

The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery

Authors: Michael K. Urban, MD, PhD, Michele Mangini-Vendel, ACNP-BC, DNP, Stephen Lyman, PhD, Ting Jung Pan, MPH, Steven K. Magid, MD

Published in: HSS Journal ® | Issue 1/2016

Login to get access

Abstract

Background

The goal of elective orthopedic surgery is to return patients to their expected level of activity without an increased incidence of postoperative complications. The first step is identifying patient and/or surgical characteristics responsible for these complications.

Questions/Purposes

This study sought to identify predictors of a step-up in medical care after non-ambulatory elective orthopedic surgery.

Methods

At a single specialty orthopedic hospital, we identified all in-hospital postoperative patients who were transferred to a higher level of medical care ((PACU) post-anesthesia care unit). The characteristics of both transferred and non-transferred patients were compared. A model was built which incorporated predictors of return to a higher level of care.

Results

During a 1-year period, 155 of 7967 patients (1.95%) required transfer to the PACU within 5 days of surgery. Cardiac complications were the major reason for transfer (50.3%), followed by pulmonary (11.0%) and neurological complications (9.7%). Patients who returned to the PACU were older, had more Exlihauser comorbidities, and had obstructive sleep apnea (OSA). In a model adjusting for all patient characteristics: age, American Society of Anesthesiologists (ASA) status, congestive heart failure (CHF), the Charlson comorbidity index and OSA predicted return to the PACU.

Conclusions

In an elderly population with multiple comorbidities undergoing elective common major orthopedic procedures, approximately 2% of patients required readmission to the PACU. The most common problems requiring this step-up in care were cardiac and pulmonary, which resulted in an increased length of hospital stay. Patients with OSA and multiple comorbidities undergoing total knee arthroplasty carry an increased risk for postoperative complications.
Appendix
Available only for authorised users
Literature
1.
Bolognesi MP, Watters TS, Attarian DE, et al. Simultaneous vs staged bilateral total knee arthroplasty among medicine beneficiaries, 2000–2009. J Arthroplasty. 2013; 28: 87-91.CrossRefPubMed
2.
Carli F, Kehlet H, Baldini G, et al. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Reg Anesth Pain Med. 2011; 36(1): 63-72.CrossRefPubMed
3.
D’Hoore W, Bouckaert A, Tilquin D. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996; 49(12): 1429-1433.CrossRefPubMed
4.
Elixhauser A, Steiner C, Harris DR, et al. Comorbidity measures for use with administrative data. Med Care. 1998; 36(1): 8-27.CrossRefPubMed
5.
Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. J Am Coll Cardiol. 2007; 50(17): e159-e241.CrossRefPubMed
6.
Friedman RJ, Hess S, Berkowitz SD, et al. Complication rate after hip or knee arthroplasty in morbidly obese patients. Clin Orthop Relat Res. 2013; 471(10): 3358-3366.PubMedCentralCrossRefPubMed
7.
Gonzalez Della Valle A, Chiu YL, Ma Y, et al. The metabolic syndrome in patients undergoing knee and hip arthroplasty: trends and in-hospital outcomes in the united states. J Arthroplasty. 2012; 27(10): 1743-1749.CrossRefPubMed
8.
Kaw R, Chung F, Pasupuleti V, et al. Meta-analysis of the association between OSA and postoperative outcome. Br J Anaesth. 2012; 109(6): 897-906.CrossRefPubMed
9.
Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89: 780-785.CrossRefPubMed
10.
Lee KJ, Carlin JB. Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation. Am J Epidemiol. 2010; 171(5): 624-632.CrossRefPubMed
11.
Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac index of major noncardiac surgery. Circulation. 1999; 100(10): 1043-1049.CrossRefPubMed
12.
Lovald ST, Ong KL, Lau EC, et al. Mortality, cost, and health outcomes after total knee arthroplasty in medicare patients. J Arthroplasty. 2013; 28(3): 449-454.CrossRefPubMed
13.
Mantilla CB, Horlocker TT, Schroeder DR, et al. Frequency of myocardial infarction, pulmonary embolism, deep venous thrombosis, and death following primary hip or knee arthroplasty. Anesthesiology. 2002; 96(5): 1140-1146.CrossRefPubMed
14.
Memtsoudis SG, Pumberger M, Ma Y, et al. Epidemiology and risk factors for perioperative mortality after total hip and knee arthroplasty. J Orthop Res. 2012; 30(11): 1811-1821.PubMedCentralCrossRefPubMed
15.
Memtsoudis SG, Sun X, Chiu YL, et al. Preoperative comparative effectiveness of anesthetic technique in orthopedic patients. Anesthesiology. 2013; 118(5): 1046-1058.PubMedCentralCrossRefPubMed
16.
Mooney JF, Ranasinghe I, Chow CK, et al. Preoperative estimates of glomerular filtration rate as predictors of outcome after surgery. Anesthesiology. 2013; 118(4): 809-824.CrossRefPubMed
17.
O’Malley NT, Fleming FJ, Gunzler DD, et al. Factors independently associated with complications and length of stay after hip arthroplasty. J Arthroplasty. 2012; 27(10): 1832-1837.CrossRefPubMed
18.
19.
Seicean A, Alan N, Seicean S, et al. Impact of increased BMI on outcomes of elective spine surgery. Spine. 2014; 22.
20.
Thornqvist C, Gislason GH, Kober L, et al. Body mass index and risk of perioperative cardiovascular events and mortality in 34,744 Danish patients undergoing hip or knee replacement. Acta Orthop. 2014; 23: 1-7.
21.
Urban MK, Chisholm M, Wukowits B. Are postoperative complications more common with single-stage bilateral (SBTKR) than with unilateral knee arthroplasty: guidelines for patients scheduled for SBTKR. HSS J. 2006; 2(1): 78-82.PubMedCentralCrossRefPubMed
22.
Urban MK, Wolfe S, Sanghavi N, et al. The one year incidence of postoperative myocardial ischemia in patients undergoing major orthopedic surgery. Poster session presented at: anesthesiology 2013. San Francisco: Annual Meeting of the American Society of Anesthesiologists; 2013.
23.
Vorhies JS, Wang Y, Herndon J, et al. Readmission and length of stay after total hip arthroplasty in a national medicare sample. J Arthroplasty. 2011; 26: 119-123.CrossRefPubMed
24.
Zmistowski B, Restrepo C, Hess J, et al. Unplanned readmission after total joint arthroplasty: rates, reasons, and risk factors. J Bone Joint Surg Am. 2013; 95(20): 1869-1876.CrossRefPubMed
Metadata
Title
The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery
Authors
Michael K. Urban, MD, PhD
Michele Mangini-Vendel, ACNP-BC, DNP
Stephen Lyman, PhD
Ting Jung Pan, MPH
Steven K. Magid, MD
Publication date
01-02-2016
Publisher
Springer US
Published in
HSS Journal ® / Issue 1/2016
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-015-9467-3

Other articles of this Issue 1/2016

HSS Journal ® 1/2016 Go to the issue

Original Article

Assessment of Osteonecrosis in the Presence of Instrumentation for Femoral Neck Fracture Using Contrast-Enhanced MAVRIC Sequence

Original Article

Validation of the Foot and Ankle Outcome Score for Hallux Rigidus

Original Article

Anteroposterior Radiographs Are More Accurate than Cross-Table Lateral Radiographs for Acetabular Anteversion Assessment: a Retrospective Cohort Study

Commentary

Bisphosphonate Drug Holiday? Celebrate?

Case Report

Lengthening of Tibia after Trans-Tibial Amputation: Use of a Weight Bearing External Fixator-Prosthesis Composite

Original Article

Initial Surgical Treatment of Humeral Shaft Fracture Predicts Difficulty Healing when Humeral Shaft Nonunion Occurs