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Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty.
J Arthroplasty 2018; 33(8):2623-2626JA

Abstract

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a major global health issue and a leading cause of morbidity and mortality. Patients with COPD are at increased risk of complications following surgery. The purpose of this study is to evaluate the postoperative total knee arthroplasty (TKA) outcomes in these patients in comparison to a non-COPD matching cohort. Specifically, we asked the following questions: (1) "Is COPD associated with adverse perioperative outcomes?" and (2) "Does COPD increase the risk of short-term complications following TKA?"

METHODS

The American College of Surgeons National Surgical Quality Improvement Program database was used to identify 111,168 patients who underwent TKA between 2008 and 2014. A total of 3975 patients with COPD were identified. Both COPD and non-COPD cohorts were compared in terms of the following outcomes: hospital length of stay, discharge disposition, and 30-day postoperative complications.

RESULTS

COPD was a predictor for a prolonged length of stay and a discharge to an extended care facility (P < .001). They were at significantly increased risk of any complication including increased mortality, pneumonia, reintubation, use of a mechanical ventilator for >48 hours, cardiac arrest, progressive renal insufficiency, deep infection, return to operating room, and a readmission within 30 days postoperatively.

CONCLUSION

Patients with COPD are more likely to experience postoperative complications following TKA when compared to non-COPD patients. Pulmonary evaluation and optimization are crucial to minimize adverse events from occurring in this difficult-to-treat population.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, Florida.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29699825

Citation

Yakubek, George A., et al. "Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty." The Journal of Arthroplasty, vol. 33, no. 8, 2018, pp. 2623-2626.
Yakubek GA, Curtis GL, Khlopas A, et al. Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty. J Arthroplasty. 2018;33(8):2623-2626.
Yakubek, G. A., Curtis, G. L., Khlopas, A., Faour, M., Klika, A. K., Mont, M. A., ... Higuera, C. A. (2018). Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty. The Journal of Arthroplasty, 33(8), pp. 2623-2626. doi:10.1016/j.arth.2018.03.011.
Yakubek GA, et al. Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty. J Arthroplasty. 2018;33(8):2623-2626. PubMed PMID: 29699825.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Knee Arthroplasty. AU - Yakubek,George A, AU - Curtis,Gannon L, AU - Khlopas,Anton, AU - Faour,Mhamad, AU - Klika,Alison K, AU - Mont,Michael A, AU - Barsoum,Wael K, AU - Higuera,Carlos A, Y1 - 2018/03/15/ PY - 2018/02/12/received PY - 2018/03/02/revised PY - 2018/03/06/accepted PY - 2018/4/28/pubmed PY - 2019/3/6/medline PY - 2018/4/28/entrez KW - Level III, Therapeutic study KW - chronic obstructive pulmonary disease KW - complications KW - discharge disposition KW - lengths of stay KW - readmission KW - total knee arthroplasty SP - 2623 EP - 2626 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 33 IS - 8 N2 - BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major global health issue and a leading cause of morbidity and mortality. Patients with COPD are at increased risk of complications following surgery. The purpose of this study is to evaluate the postoperative total knee arthroplasty (TKA) outcomes in these patients in comparison to a non-COPD matching cohort. Specifically, we asked the following questions: (1) "Is COPD associated with adverse perioperative outcomes?" and (2) "Does COPD increase the risk of short-term complications following TKA?" METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was used to identify 111,168 patients who underwent TKA between 2008 and 2014. A total of 3975 patients with COPD were identified. Both COPD and non-COPD cohorts were compared in terms of the following outcomes: hospital length of stay, discharge disposition, and 30-day postoperative complications. RESULTS: COPD was a predictor for a prolonged length of stay and a discharge to an extended care facility (P < .001). They were at significantly increased risk of any complication including increased mortality, pneumonia, reintubation, use of a mechanical ventilator for >48 hours, cardiac arrest, progressive renal insufficiency, deep infection, return to operating room, and a readmission within 30 days postoperatively. CONCLUSION: Patients with COPD are more likely to experience postoperative complications following TKA when compared to non-COPD patients. Pulmonary evaluation and optimization are crucial to minimize adverse events from occurring in this difficult-to-treat population. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/29699825/Chronic_Obstructive_Pulmonary_Disease_Is_Associated_With_Short_Term_Complications_Following_Total_Knee_Arthroplasty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(18)30251-1 DB - PRIME DP - Unbound Medicine ER -