Caleb R. Szubski

Primary total knee arthroplasty allogenic transfusion trends, length of stay, and complications: nationwide inpatient sample 2000-2009.

Perioperative blood loss leading to blood transfusion continues to be an issue for total knee arthroplasty (TKA) patients. The US Nationwide Inpatient Sample (NIS) was used to determine annual trends in allogenic blood transfusion rates, and effects of transfusion on in-hospital mortality, length of stay (LOS), costs, discharge disposition, and complications of primary TKA patients. TKA patients between 2000 and 2009 were included (n = 4,544,999) and categorized as: (1) those who received a transfusion of allogenic blood, and (2) those who did not. Transfusion rates increased from 7.7% to 12.2%. For both transfused and not transfused groups, mortality rates and mean LOS declined, while total costs increased. Transfused patients were associated with adjusted odds ratios of in-hospital mortality (AOR 1.16; P = 0.184), 0.71 ± 0.01 days longer LOS (P < 0.0001), and incurred (

Activity Levels and Functional Outcomes of Young Patients Undergoing Total Hip Arthroplasty

1777 ± 36; P < 0.0001) higher total costs per admission.

Prospective, Randomized Trial to Evaluate Efficacy of a Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty

The activity demands of young patients undergoing total hip arthroplasty (THA) have not been clearly defined. University of California Los Angeles (UCLA) activity score, Hip disability and Osteoarthritis Outcome Score (HOOS), Short Form-12 version 2 (SF-12v2), and Functional Comorbidity Index (FCI) questionnaires were administered to 70 young patients who had undergone THA (young THA group; ie, ≤30 years old), 158 general patients who had undergone THA (general THA group; ie, ≥31 years old), and 106 young, comorbidity-matched patients who had not undergone arthroplasty and had no significant hip disease (nonarthroplasty group). Mean postoperative UCLA activity scores were similar among groups (young THA group, 6.5; general THA group, 6.4; nonarthroplasty group, 6.6) before and after adjustment for comorbidity, sex, and race (P=.62 and P=.47, respectively). Adjusted analyses also found a negative association between postoperative activity and increases in comorbidity and female sex (P<.001). Patients in the young THA group reported higher expectations of postoperative activity (7.7) than those in the general THA group (7.1; P=.02). Postoperative HOOS results showed greater hip symptoms (P=.003) and poorer hip-related quality of life (P<.001) in the young THA group. Patient groups had similar postoperative SF-12v2 physical health scores (P=.31), although mental health scores were significantly higher in the general THA group (P<.001). The interesting finding of lower postoperative expectations, greater hip-related quality of life, and better mental health scores in the general THA group may indicate a need for better management of expectations in young patients undergoing THA, including a discussion of realistic gains in activity and potential comorbidity-related restrictions.

Early Postoperative Outcomes of Primary Total Knee Arthroplasty After Solid Organ Transplantation in the United States, 1998-2011.

Total knee arthroplasty (TKA) can be associated with substantial blood loss, leading to increased morbidity and transfusion rates. The study objective was to evaluate routine use of a thrombin-based topical hemostatic matrix in reducing blood loss and transfusion requirements in primary TKA. 108 patients were enrolled in a prospective, randomized, single-center trial. Patients receiving the hemostatic agent demonstrated a lower mean calculated blood loss (1325.2±464.8mL vs. control, 1509.3±432.8mL; P=0.02), drain output (415.6±202.0mL vs. control, 579.9±306.7mL; P=0.008), and length of stay (3.3±0.8days vs. control, 3.7±1.1days; P=0.03), without a statistically significant difference in mean hemoglobin loss or transfusion requirements. The clinical utility of this hemostatic agent to reduce transfusions after uncomplicated, primary TKA continues to remain unclear.

Predicting Discharge to a Long-Term Acute Care Hospital After Admission to an Intensive Care Unit

This review of the Nationwide Inpatient Sample (1998-2011) examined trends in solid organ transplant patients who received a total knee arthroplasty (TKA) to determine whether length of stay (LOS), cost, and perioperative complications differed from non-transplant peers. Primary TKA patients (n=5,870,421) were categorized as: (1) those with a history of solid organ transplant (n=6104) and (2) those without (n=5,864,317). Propensity matching was used to estimate adjusted effects of solid organ transplant history on perioperative outcomes. The percentage of TKA patients with a transplant history grew during the study period from 0.069% to 0.103%. Adjusted outcomes showed patients with a transplant had a 0.44 day longer LOS,

Prospective, Randomized Trial to Evaluate Efficacy of a Bipolar Sealer in Direct Anterior Approach Total Hip Arthroplasty

962 higher cost of admission, and were 1.43 times more likely to suffer any complication (P=0.0002).

Relative efficacy of tranexamic acid and preoperative anemia treatment for reducing transfusions in total joint arthroplasty

BACKGROUND Long-term acute care hospitals are an option for patients in intensive care units who require prolonged care after an acute illness. Predicting use of these facilities may help hospitals improve resource management, expenditures, and quality of care delivered in intensive care. OBJECTIVE To develop a predictive tool for early identification of intensive care patients with increased probability of transfer to such a hospital. METHODS Data on 1967 adults admitted to intensive care at a tertiary care hospital between January 2009 and June 2009 were retrospectively reviewed. The prediction model was developed by using multiple ordinal logistic regression. The model was internally validated via the bootstrapping technique and externally validated with a control cohort of 950 intensive care patients. RESULTS Among the study group, 146 patients (7.4%) were discharged to long-term acute care hospitals and 1582 (80.4%) to home or other care facilities; 239 (12.2%) died in the intensive care unit. The final prediction algorithm showed good accuracy (bias-corrected concordance index, 0.825; 95% CI, 0.803-0.845), excellent calibration, and external validation (concordance index, 0.789; 95% CI, 0.754-0.824). Hypoalbuminemia was the greatest potential driver of increased likelihood of discharge to a long-term acute care hospital. Other important predictors were intensive care unit category, older age, extended hospital stay before admission to intensive care, severe pressure ulcers, admission source, and dependency on mechanical ventilation. CONCLUSIONS This new predictive tool can help estimate on the first day of admission to intensive care the likelihood of a patients discharge to a long-term acute care hospital.

Comparison of complications associated with commercially available and custom-made articulating spacers in two-stage total hip arthroplasty revision

Total hip arthroplasty can be associated with substantial blood loss requiring allogenic transfusions. Intraoperative blood loss patterns in DAA differ from other approaches. This study evaluated the hemostatic efficacy of a bipolar sealer in DAA THA on surgical blood loss and transfusion requirements. 118 patients were enrolled in this prospective, randomized, double-blinded trial. Primary outcome measure was transfusion rate, while secondary measures included calculated blood loss. A lower transfusion rate was found in the treatment group (3.5 % vs 16.4%, P=.03). There were differences in Hemoglobin-drop (P=.04), calculated blood loss (P=.02), and hidden blood loss (P=.02), favoring the treatment group. The use of a bipolar sealer decreased intraoperative blood loss and transfusion requirements in the study population.

Functional outcomes used to compare single radius and multiradius of curvature designs in total knee arthroplasty.

This study aimed to evaluate the efficacy of a perioperative blood management (PBM) protocol at a large, tertiary hospital at reducing blood transfusions after total hip or knee arthroplasty (THA or TKA).

Day of Surgery Affects Length of Stay and Charges in Primary Total Hip and Knee Arthroplasty.

Background:Two-stage revision with interim placement of an articulating antibiotic-loaded spacer is the “gold standard” for prosthetic hip joint infection treatment. However, commercially available and custom-made articulating spacer options exist. This study presents a comparison of these two spacer types in terms of interim complications (periprosthetic fracture, spacer dislocation, infection), post second-stage infection control, and a minimum 2-year functional and general health outcomes. Methods:Seventy-eight patients between January 1999 and August 2008 were treated with a two-stage revision, with placement of an articulating spacer during the interim period. Interim complication data, radiographic evaluation, and infection follow-up status were retrospectively reviewed. Additionally, modified Harris Hip Score and Short Form-12v2 scores were collected at a mean follow-up of 58.3 months (range, 24.3-135.3 months). Results:There were no statistically significant differences in interim complication rates between commercially available (n=27) (prefabricated, n=13; mold systems, n=14) and noncommercial custom-made (n=51) articulating spacer groups. However, there was a higher recurrence of infections after the second-stage procedure in the custom-made spacer group (21.6% compared with 0.0%) (P=0.001). Similar functional and general health outcomes, as well as instances of prosthesis loosening, were found between spacer types at last office follow-up visit. Conclusions:These data suggest that custom-made articulating spacers, which allow flexibility in construction at often cheaper costs than commercially available options, offer similar performance in terms of mechanical complications. However, more emphasis may need to be placed on antibiotic choice and concentration to decrease the incidence of infection recurrence.