J Knee Surg 2023; 36(03): 335-343
DOI: 10.1055/s-0041-1733883
Original Article

Chronic Obstructive Pulmonary Disease Associated with Prolonged Opiate Use, Increased Short-Term Complications, and the Need for Revision Surgery following Total Knee Arthroplasty

Nicholas J. Lemme
1   Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Jillian Lynn Glasser
2   Department of Adult Reconstruction, University Orthopedics, East Providence, Rhode Island
,
Daniel S. Yang
1   Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Edward J. Testa
1   Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
,
Alan H. Daniels
1   Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
3   Department of Spine Surgery, University Orthopedics, East Providence, Rhode Island
,
Valentin Antoci
1   Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
2   Department of Adult Reconstruction, University Orthopedics, East Providence, Rhode Island
› Author Affiliations
Funding None.

Abstract

Chronic obstructive pulmonary disease (COPD) is a condition which causes a substantial burden to patients, physicians, and the health care system at large. Medical comorbidities are commonly associated with adverse health outcomes in the postoperative period. Here, we present a large database review of patients undergoing total knee arthroplasty (TKA) to determine the effect of COPD on patient outcomes. The PearlDiver database was queried for all patients who underwent TKA between 2007 and the first quarter of 2017. Medical complications, surgical complications, 30-day readmission rates, revision rates, and opioid utilization were assessed at various intervals following TKA among patients with and without COPD. Multivariable regression was used to calculate adjusted odds ratios controlling for age, sex, and medical comorbidities. A total of 46,769 TKA patients with COPD and 120,177 TKA patients without COPD were studied. TKA patients with COPD experienced increased risk of 30-day readmission (40.8% vs. 32.2%, p < 0.0001), 30-day total medical complications (10.2% vs. 7.0%, p < 0.0001), prosthesis explanation at 6 months (0.4% vs. 0.2, p = 0.0130), 1 year (0.6% vs. 0.3%, p = 0.0005), and 2 years (0.8% vs. 0.5%, p = 0.0003), as well as an increased rate of revision (p < 0.0046) compared to TKA patients without COPD. Opioid utilization of TKA patients with COPD was greater significantly than that of TKA patients without COPD at 3, 6, and 12 months. Patients with COPD have an increased risk for medical and surgical complications, readmission, and prolonged opioid use following TKA.



Publication History

Received: 19 January 2021

Accepted: 21 June 2021

Article published online:
16 September 2021

© 2021. Thieme. All rights reserved.

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