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J Knee Surg 2020; 33(11): 1100-1108
DOI: 10.1055/s-0039-1692630
Original Article

Postoperative Complications Causing Readmission in 30 Days after Total Knee Arthroplasty: A Retrospective Nested Case-Control Study of Risk Factors Based on Propensity Score Matching

Haozheng Tang
1   Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China
,
Hui Li
1   Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China
,
Shutao Zhang
1   Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China
,
You Wang
1   Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China
,
Xinhua Qu
1   Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China
,
Bing Yue
1   Department of Bone and Joint Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, People’s Republic of China
› Author Affiliations
Funding This work was supported by National Natural Science Foundation of China [81472119 and 81672196], Shanghai municipal education commission-Gaofeng clinical medicine grant support [20161423] and Shanghai Rising Stars of Medical Talent Youth Development Program (Youth Medical Talents – Specialist Program).
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Abstract

We performed this study to identify independent risk factors for life-threatening postoperative complications causing 30-day readmissions after total knee arthroplasty (TKA). Improved understanding of these risks may improve efficiency and safety of treatment. We performed a retrospective, nested case-control study using an open-access database of 2,622 patients who underwent primary TKA at a tertiary academic medical center in Singapore between January 2013 and June 2014. Patients were grouped according to the incidence of complications. Multivariate logistic analysis was performed to identify predictive factors for TKA complications. The incidence of postoperative complications was 1.72%. Compared with cases performed with an operative time < 70 minutes, increased operative time was associated with a higher risk of complications. Case duration > 90 minutes was associated with an increased risk (adjusted odds ratio [aOR] = 4.57, p = 0.001; case duration ≥ 111 minutes, aOR = 4.64, p = 0.04; and case duration between 91 and 110 minutes, aOR = 3.20, p = 0.03). The correlation between operative time and complications was nonlinear. Cerebrovascular accident (CVA) or transient ischemic attack (TIA) was an independent risk factor for increased complication rate (aOR = 11.59, p = 0.02). Operative duration has been identified as an independent risk factor for complications after TKA. As it remains a modifiable factor to which doctors are interested in bringing quality improvement, the risk of postoperative complications will be reduced by minimizing the operative duration.

Keywords

total knee arthroplasty (TKA) - postoperative complication - operative duration - retrospective nested case-control study - propensity score matching (PSM)

Ethical Approval

All procedures performed in studies involving human participants have already been in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standard in original study.


Informed Consent

In this research, informed consent has been obtained from all individual participants included in the original study.




Publication History

Received: 11 December 2018

Accepted: 05 May 2019

Article published online:
29 July 2019

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