International Orthopaedics

, Volume 42, Issue 5, pp 1197–1197 | Cite as

Comment on Saku et al.: Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre

  • Lucas J. Castro Alves
  • Mark C. Kendall
Letter to the Editor

Dear Editor,

We read with great interest the article of Saku and colleagues in a recent issue of the journal [1]. The authors performed a retrospective cohort study on 861 patients undergoing total knee arthroplasty and concluded that knee pain was the second most common reason for re-admission accounting for 14.1% of total re-admissions. The authors should be congratulated for performing a well-designed study in an important topic (e.g., hospital re-admissions) in patients undergoing surgery [2, 3]. In addition, the current emphasis on use of multimodal analgesic strategies to enhance recovery across many surgical procedures makes the topic timely in peri-operative medicine [4, 5].

Although the study of Saku et al. was well conducted, there are some questions regarding the study that need to be clarified by the authors. First, the authors’ data revealed 116 unplanned re-admissions but they examined more than 20 predictor variables in their analysis leading to a substantial overfitting of the model. The authors did not provide any explanation or evaluation for this problem. Secondly, there is no analysis of post-operative analgesic strategies which may be the main factor leading to pain-related re-admissions and a significant confounder for the study results. Lastly, education and health literacy may have also been linked to hospital re-admissions in other clinical settings [6]. Nonetheless, these variables were not evaluated in the model.

We would welcome some comments to address the aforementioned issues as they were not discussed by the authors. This would help to further validate the findings of this important clinical study.


Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Saku SA, Madanat R, Mäkinen TJ (2018) Reasons and risk factors for ninety day re-admission following primary total knee arthroplasty in a high-volume centre. Int Orthop 42:95–99CrossRefPubMedGoogle Scholar
  2. 2.
    Herbst MO, Price MD, Soto RG (2017) Pain related readmissions/revisits following same-day surgery: Have they decreased over a decade? J Clin Anesth 42:15CrossRefPubMedGoogle Scholar
  3. 3.
    Chow J, Fitch DA (2017) In-hospital costs for total hip replacement performed using the supercapsular percutaneously-assisted total hip replacement surgical technique. Int Orthop 41:1119–1123CrossRefPubMedGoogle Scholar
  4. 4.
    Asgari Z, Rouholamin S, Nataj M, Sepidarkish M, Hosseini R, Razavi M (2017) Dose ranging effects of pregabalin on pain in patients undergoing laparoscopic hysterectomy: a randomized, double blinded, placebo controlled, clinical trial. J Clin Anesth 38:13–17CrossRefPubMedGoogle Scholar
  5. 5.
    Kıtlık A, Erdogan MA, Ozgul U et al (2017) Ultrasound-guided transversus abdominis plane block for postoperative analgesia in living liver donors: a prospective, randomized, double-blinded clinical trial. J Clin Anesth 37:103–107CrossRefPubMedGoogle Scholar
  6. 6.
    Mitchell SE, Sadikova E, Jack BW, Paasche-Orlow MK (2012) Health literacy and 30-day post-discharge hospital utilization. J Health Commun 17:325–338CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology, Rhode Island HospitalThe Warren Alpert Medical School of Brown UniversityProvidenceUSA

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