Abstract
Introduction
In view of the vaso-occlusive pathophysiology affecting osseous micro-circulation, sickle cell disease (SCD) is well known to present with diverse skeletal and arthritic manifestations. With prolonged life-expectancy over the past decades, there has been a progressive increase in the proportion of SCD patients requiring joint reconstructions. Owing to the paucity of evidence in the literature, the post-operative complication rates and outcome in these patients following total knee arthroplasty (TKA) are still largely unknown.
Methods
Based on the National Inpatient Sample (NIS) database (using ICD-10 CMP code), patients who underwent TKA between 2016 and 2019 were identified. The cohort were classified into two groups: A—those with SCD; and B—those without. The data on patients’ demographics, co-morbidities, details regarding hospital stay including expenditure incurred, and complications were analyzed and compared.
Results
Overall, 558,361 patients underwent unilateral, primary TKA; among whom, 493 (0.1%) were known cases of SCD (group A). Group A included a significantly greater proportion of younger (60.14 ± 10.87 vs 66.72 ± 9.50 years; p < 0.001), male (77.3 vs 61.5%; p < 0.001); and African-American (88.2 vs 8.3%B; p < 0.001) patients, in comparison with group B. Group A patients were also at a significantly higher risk for longer duration of peri-operative hospital stay (p < 0.001), greater health-care costs incurred (p < 0.001), and greater need for alternative step-down health-care facilities (p < 0.001) following discharge. Among the SCD patients, 24.7%, 20.9% and 24.9% developed acute chest syndrome, pain crisis and splenic sequestration crisis, respectively during the peri-operative period. Group A patients had a statistically greater incidence of acute renal failure (ARF; p = 0.014), need for blood transfusion (p < 0.001) and deep vein thrombosis (DVT; p = 0.03) during the early admission period.
Conclusion
The presence of SCD substantially lengthens the duration of hospital stay and enhances health care-associated expenditure in patients undergoing TKA. SCD patients are at significantly higher risk for systemic complications including acute chest syndrome, pain crisis, splenic sequestration crisis, acute renal failure, higher need for blood transfusions and deep venous thrombosis during the initial peri-operative period following TKA.
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VKV—data processing, data analysis, reviewing manuscript content, overseeing manuscript preparation and language editing. SPR—data analysis, writing up manuscript, reviewing and language editing. JB—data processing, data analysis, preparing tables, language editing, proof reading. SS—data procurement and processing, data analysis, reviewing manuscript content and language editing. VM—formulating research methodology, reviewing manuscript content and overseeing manuscript preparation. SS—conception, formulating research methodology, data procurement and processing, data analysis, reviewing manuscript, proof reading and submitting.
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Appendix 1
Appendix 1
ICD codes used.
SLE | Obese codes | Morbidly obese codes | Comorbidities codes | Medical complications codes | Surgical complications codes |
|---|---|---|---|---|---|
M32 M321 M3210 M3211 M3212 M3213 M3214 M3215 M3219 M328 M329 | E660 E6601 E6609 E661 E662 E668 E669 Z6830 Z6831 Z6832 Z6833 Z6834 Z6835 Z6836 Z6837 Z6838 Z6839 | Z6841 Z6842 Z6843 Z6844 Z6845 | Diabetes without complications E119 Diabetes with complications E1169 Tobacco related disorder Z87891 | Acute renal Failure N170, N171, N172, N178, N179 Myocardial Infarction I2101, I2102, I2111, I2113, I12114, I12119, I2121, I12129, I21A1 Blood loss anemia D62 Pneumonia J189, J159, J22 Blood transfusion 30233N1 Pulmonary embolism I2602, I2609, I2692, I2699 DVT I82401,I82402, I82403, I82409, I82411, I82412, I82413, I82419, I82421, I82422, I82423, I82429, I82431, I82432, I82433, I82439, I82441, I82442, I82443, I82449, I82491, I82492, I82493, I82499, I824Y1, I824Y2, I824Y3, I824Y9, I824Z1, I824Z2, I824Z3, I824Z4 | Periprosthetic fracture T84010A, T84011A, T84012A, T84013A, T84018A, T84019A, M9665, M96661, M96662, M96669, M96671, M96672, M96679, M9669, M9701XA, M9702XA, M9711XA, M9712XA Periprosthetic dislocation T84020A, T84021A, T84022A, T84023A, T84028A, T84029A Periprosthetic mechanical complications T84090A, T84091A, T84092A, T84093A, T84098A, T84099A Periprosthetic Infection T8450XA, T8451XA, T8452XA, T8453XA, T8454XA, T8459XA Superficial SSI T8141XA Deep SSI T8142XA Wound Dehiscence T8130XA, T8131XA, T8132XA |
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Viswanathan, V.K., Ramanan, S.P., Beale, J. et al. How does sickle cell disease affect the peri-operative outcome in patients undergoing total knee arthroplasty? A large-scale, National Inpatient Sample-based study. Arch Orthop Trauma Surg 143, 5261–5268 (2023). https://doi.org/10.1007/s00402-022-04762-1
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DOI: https://doi.org/10.1007/s00402-022-04762-1