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.
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Disclosures
Conflict of Interest
Michael K. Urban, MD, PhD, Michele Mangini-Vendel, ACNP-BC, DNP, Stephen Lyman, PhD, Ting Jung Pan, MPH and Steven K. Magid, MD have declared that they have no conflict of interest.
Human/Animal Rights
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed Consent
Informed consent was waived from all patients for being included in the study.
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Work was performed by Hospital for Special Surgery.
Level of Evidence: Prognostic study, level II
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Urban, M.K., Mangini-Vendel, M., Lyman, S. et al. The Need for a Step-up in Postoperative Medical Care is Predictable in Orthopedic Patients Undergoing Elective Surgery. HSS Jrnl 12, 59–65 (2016). https://doi.org/10.1007/s11420-015-9467-3
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DOI: https://doi.org/10.1007/s11420-015-9467-3