PURPOSE: To elucidate trends in the prevalence of procedure related complications and pulmonary embolism (PE) after total knee arthroplasty (TKA) among hospitalized patients.
METHODS: Data collected for each year between 1990 and 2004 in the NHDS was read into a statistical software program and analyzed. Discharges with at least one procedure code (ICD-9-CM) for TKA (81.54) were included in the sample. Three five-year time periods were created (1990–1994, 1995–1999, 2000–2004) to simplify temporal analysis. Trends in demographics (incl. comorbidity profiles) and in the prevalence of procedure-related respiratory complications were evaluated. The occurrence rates of in-hospital mortality and PE were also studied and changes tested for significance.
RESULTS: We identified 3,830,420 discharges of patients having undergone TKA from 1990 to 2004. The prevalence of TKA increased by 125% from the first to the last time period of study. The average age (69.13 vs. 67.58 years) and length of stay decreased (8.43 vs. 4.18 days), accompanied by an increase of discharges to long and short term care facilities. As for other comorbidities, the prevalence of pulmonary comorbidities increased over time (6.40% in 1990–1994, in 7.83% in 1995–1999 and 10.33% in 2000–2004). While procedure related respiratory complications (1.63% in 1990–1994 vs. 1.34% in 1995–1999 vs. 0.84% in 2000–2004, respectively) and procedure related adverse events in general (14.22% vs. 11.49% vs. 7.50%, respectively decreased over time, the prevalence of PE (0.36% vs. 0.29 vs. 0.52%) increased. Concurrently, in-hospital mortality decreased from 0.50% to 0.21% before climbing to 0.29% in the most recent time period. Among fatalities PE was the leading adverse diagnosis reaching a prevalence of 26.3% in the most recent period of study.
CONCLUSION: Despite limitations inherent to secondary analysis of large databases, we were able to identify a number of significant trends in the prevalence of pulmonary comorbidities, procedure related respiratory complications and PE.
CLINICAL IMPLICATIONS: Further studies are warranted to evaluate if increased rates of in in-hospital mortality and PE are linked to the increase in pulmonary comorbidities among TKA patients.
DISCLOSURE: Stavros Memtsoudis, No Financial Disclosure Information; No Product/Research Disclosure Information