CORRInsights®: What Is the Timing of General Health Adverse Events That Occur After Total Joint Arthroplasty?

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Postoperative adverse events, including life-threatening complications such as myocardial infarction and pulmonary embolism (PE) can occur in 1% to 4% of patients undergoing primary total joint arthroplasty (TJA) [2]. However, most data related to general health adverse events in patients who underwent TJA are collected in-hospital and there is a relative lack of identification and documentation of adverse events after discharge.
It would be important to learn more about this topic, because of the increasing popularity of fast-track recovery programs, progressively shortening hospital stays, and outpatient TJAs. On this topic, Courtney and colleagues [3] used the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database to compare all patients undergoing primary TKA or THA from 2011 to 2014. They found an overall complication rate of 8% and 16% for outpatient and inpatient groups, respectively, during the first 30 days after surgery, and saw no increased risk of readmission or reoperation following outpatient TJA.
This set the stage for the study by Bohl and colleagues. In their study, the authors analyzed 124,657 patients who underwent primary TJA between 2005 and 2013 from the ACS-NSQIP database to identify the timing of certain adverse events and the proportion of adverse events occurring after the patient has been discharged from the hospital. Though the type and incidence of such adverse events and complications after TJAs is well reported [3, 8], we lack specific timing and characterization of such events.
The authors found that the median time to many important, life-threatening complications—stroke, myocardial infarction, PE, and pneumonia—was 4 days, whereas other adverse events such as deep vein thrombosis (DVT), urinary tract infection, sepsis, and surgical site infection generally occurred later, at a median of 5 to 20 days after surgery. Additionally, the timing for PE and DVT was earlier in patients undergoing TKA compared to those undergoing THA. This earlier occurrence of thromboembolic events in TKA patients could be from the increased venous compression associated with tourniquet use and knee flexion during TKA.
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