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Inpatient Revision Total Knee Arthroplasty Has a Higher Risk of Early Complications: A Propensity Score-Matched
Kevin D Plancher1, Carlo M Mannina2, Elias N Schwartz2
1Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; Department of Orthopaedic Surgery, Weill Cornell Medical College, New York, New York; Plancher Orthopaedics & Sports Medicine, New York, New York; Orthopaedic Foundation, Stamford, Connecticut.
Background:
With the rise in outpatient elective surgery, the safety of revision total knee arthroplasty (TKA) as an outpatient procedure has been questioned. This study compared surgical outcomes and complications of inpatient versus outpatient revision TKA using a large national database.
Methods:
The database was queried for patients who underwent outpatient and inpatient revision TKA. Groups were propensity-matched by age, sex, one or two-component revision, and the Elixhauser Comorbidity Index, resulting in 7,728 patients per group. Outcome measures included 2-year re-revision, 90-day hospital readmission, manipulation under anesthesia, and 6-month medical complications. Queries were based on Current Procedural Terminology and International Classification of Diseases codes. Binomial logistic regression was used to determine predictors of failure.
Results:
Hospital readmissions were higher in the inpatient revision TKA group (P < 0.001). The inpatient group had higher rates of blood transfusion (odds ratio (OR): 2.0 (1.6 to 2.5) P < 0.001), deep vein thrombosis (OR: 1.8 (1.1 to 2.8) P = 0.02), pulmonary embolism (OR: 2.7 (1.7 to 4.2) P < 0.001), acute kidney injury (OR: 1.5 (1.3 to 1.8) P < 0.001), and periprosthetic joint infection (OR: 1.5 (1.4 to 1.7), P < 0.001). Independent predictors of failure in the inpatient group were age (P < 0.001), two-component revision (OR: 3.7 (3.1 to 4.4) P < 0.001), and infection (OR: 3.9 (3.3 to 4.7) P < 0.001) and in the outpatient group were age (P < 0.001), Elixhauser Comorbidity Index (P = 0.03), two-component revision (OR: 4.2 (3.6 to 5.0) P < 0.001), and infection (OR: 3.9 (3.2 to 4.7) P < 0.001).
Conclusions:
Outpatient revision TKA did not carry a higher risk of medical complications, hospital readmissions, or re-revision. Inpatient revision TKA had a higher incidence of medical complications. While inpatient care remains important for patients with complex medical conditions, outpatient revision TKA is a safe and effective option in appropriately-selected patients.
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