While TJA procedures are becoming better managed from a pain and blood loss standpoint, there remains a low, but important risk of mortality inherent in the fact these are large surgical procedures in a relatively old patient population.
Courtney et al. examined 1,012 patients undergoing primary THA or TKA and found that 84% of medical complications occurred within 24 hours postop and 90% occurred within 4 days. These patients had higher incidence of major comorbidities such as CHF, CAD, COPD, and liver failure. Older age was an additional risk factor . In contrast however, a similar study that examined the timing of major postoperative complications found that over 90% occurred within the first 4 days of surgery yet almost 60% of cases occurred in patients without significant comorbidities . Overall, it appears that cardiac failure was the most common cause of mortality, pulmonary embolism was the second.
Identifying patient risk factors is an important part of pre-operative preparation for TJA. Large national databases have been used recently to further identify risk factors for medical complications.
Age (>80), diabetes, BMI > 40, and ASA class (>3, indicator of comorbidities) were all associated with increased risk of 30 day morbidity and mortality after TKA . Age and cardiac disease were associated with 30 day risk in THA . Looking specifically at cardiac complications, hypertension and coronary artery disease comorbities as well as age > 80 were risk factors..
These studies highlight the importance of preoperative screening to identify the risk factors that place a patient at risk for medical complications in the acute postoperative period and require hospital monitoring.
Medical complications are also associated with hospital readmission.
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