Incidence and timing of postoperative complications after total hip and knee arthroplasty

被引:0
作者
Diaz-Dilernia, Fernando [1 ,2 ]
Steinfeld, Yaniv [1 ]
Pincus, Daniel [1 ]
Spangehl, Mark [3 ]
Ravi, Bheeshma [1 ,4 ]
机构
[1] Univ Toronto, Sunnybrook Hlth Sci Ctr, Dept Surg, Div Orthopaed Surg, Toronto, ON, Canada
[2] Queens Univ, Kingston Gen Hosp, Kingston Hlth Sci Ctr, Div Orthoped Surg,Dept Surg, Kingston, ON, Canada
[3] Mayo Clin Arizona, Phoenix, AZ USA
[4] ICES Cent, Toronto, ON, Canada
关键词
JOINT ARTHROPLASTY; READMISSION; REPLACEMENT; CARE;
D O I
10.1503/cjs.04724
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background Follow-up protocols after total hip or knee arthroplasty (THA or TKA, respectively) have little uniformity, which can lead to emergency department (ED) visits for postoperative complications. We sought to determine the incidence and timing of postoperative complications after THA or TKA.Methods We conducted a population-based retrospective cohort study of all adults in Ontario who underwent primary THA or TKA between 2010 and 2019. We used data available through ICES. We identified medical and surgical complications, ED visits, and hospital readmissions using institutional databases and Ontario Health Insurance Plan claims. Outcomes included major medical complications within 30 days and surgical complications within 1 year after surgery.Results We included 158 503 and 103 728 patients who underwent TKA and THA, respectively. The incidence of medical complications within 30 days was 2.90% after TKA and 2.42% after THA. Visits to the ED (20.0% after TKA, 16.9% after THA) and readmission rates within 30 days (3.8% after TKA, 4.1% after THA) were similar for both groups. Visits to the ED occurred at a median of 10 days after surgery for both groups, with readmissions at a median of 12 and 13 days after TKA and THA, respectively. The incidence of major TKA complications was 1.6%, with a median time of 84 (interquartile range [IQR] 26-224) days. The incidence of major THA complications was 2.2%, with a median time of 29 (IQR 16-80) days.Conclusion Our findings suggest follow-up contact 7-10 days after THA or TKA to minimize ED visits, with at least 1 subsequent in-person follow-up at 5-6 weeks after surgery. After that, surgeons may personalize additional follow-ups as needed. Contexte: Les protocoles de suivi apr & egrave;s une arthroplastie totale de la hanche (ATH) ou du genou (ATG) manquent d'uniformit & eacute;, ce qui peut entra & icirc;ner des complications postop & eacute;ratoires n & eacute;cessitant une visite aux services des urgences (SU). Nous avons cherch & eacute; & agrave; d & eacute;terminer l'incidence et le moment des complications & agrave; la suite d'une ATH ou d'une ATG.M & eacute;thodes: Nous avons men & eacute; une & eacute;tude de cohorte r & eacute;trospective bas & eacute;e sur la population de l'ensemble des adultes en Ontario ayant subi une ATH ou une ATG primaire entre 2010 et 2019, identifi & eacute;s & agrave; partir des donn & eacute;es de l'ICES. En parcourant les bases de donn & eacute;es d'& eacute;tablissements et des demandes de remboursement du R & eacute;gime d'assurance-sant & eacute; de l'Ontario, nous avons r & eacute;pertori & eacute; les complications m & eacute;dicales et chirurgicales, les visites aux SU et les r & eacute;hospitalisations. Les param & egrave;tres comprenaient les complications m & eacute;dicales majeures dans les 30 jours et les complications chirurgicales dans l'ann & eacute;e suivant l'op & eacute;ration.R & eacute;sultats: Nous avons inclus 158 503 personnes ayant subi une ATG, et 103 728 ayant subi une ATH. L'incidence des complications m & eacute;dicales dans les 30 jours & eacute;tait de 2,90 % apr & egrave;s l'ATG et de 2,42 % apr & egrave;s l'ATH. Les taux de visites aux SU (20,0 % apr & egrave;s l'ATG, 16,9 % apr & egrave;s l'ATH) et de r & eacute;hospitalisation dans les 30 jours (3,8 % apr & egrave;s l'ATG, 4,1 % apr & egrave;s l'ATH) & eacute;taient semblables pour les 2 groupes. La m & eacute;diane du moment de la visite aux SU & eacute;tait de 10 jours apr & egrave;s l'op & eacute;ration pour les 2 groupes, tandis que la m & eacute;diane du moment de la r & eacute;hospitalisation & eacute;tait de 12 jours apr & egrave;s l'ATG et 13 jours apr & egrave;s l'ATH. L'incidence des complications majeures de l'ATG s'& eacute;levait & agrave; 1,6 %, avec un intervalle m & eacute;dian de 84 (& eacute;cart interquartile [& Eacute;I] 26-224) jours. L'incidence des complications majeures de l'ATH s'& eacute;levait & agrave; 2,2 %, avec un intervalle m & eacute;dian de 29 (& Eacute;I 16-80) jours.Conclusion: Nos r & eacute;sultats sugg & egrave;rent qu'un suivi 7-10 jours apr & egrave;s une ATH ou une ATG permettrait de r & eacute;duire les visites aux SU, avec au moins 1 consultation en personne 5-6 semaines apr & egrave;s l'op & eacute;ration. Les chirurgiens et chirurgiennes pourront ensuite adapter le suivi aux besoins.
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页码:E377 / E382
页数:6
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