Evidence map›Paper›PMID 35377079›Full record

ArticleEuropean journal of orthopaedic surgery & traumatology : orthopedie traumatologie2023

Simultaneous bilateral total knee arthroplasty has higher in-hospital complications than both staged surgeries: a nationwide propensity score matched analysis of 38,764 cases.

Michael Erossy, Ahmed K Emara, Guangjin Zhou, Siran Kourkian, Alison K Klika, Robert M Molloy, Nicolas S Piuzzi

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Article in European journal of orthopaedic surgery & traumatology : orthopedie traumatologie, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Michael ErossyDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Ahmed K EmaraDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Guangjin ZhouDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Siran KourkianDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Alison K KlikaDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Robert M MolloyDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA.
Nicolas S PiuzziDepartment of Orthopedic Surgery, Cleveland Clinic, Orthopaedic and Rheumatology Institute, 9500 Euclid Avenue, A41, Cleveland, OH, 44195, USA. piuzzin@ccf.org.ORCID http://orcid.org/0000-0003-3007-7538

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo investigate (1) healthcare utilization, (2) in-hospital metrics and (3) total in-hospital costs associated with simultaneous versus staged BTKA while evaluating staged BTKA as a single process consisting of two combined episodes.

methodsThe national readmissions database was reviewed for simultaneous and staged (two primary unilateral TKAs12 months apart) BTKA patients (2016-2017). A total of 19,382 simultaneous BTKAs were identified, and propensity score matched (1:1) to staged BTKA patients (19,382 patients; 38,764 surgeries) based on demographics, comorbidities, and socioeconomic determinants. Outcomes included healthcare utilization [length of stay (LOS) and discharge disposition], in-hospital periprosthetic fractures, non-mechanical complications, and costs. Staged BTKA was evaluated as one process consisting of two episodes. For each staged patient, continuous outcomes were evaluated via the sum of both episodes. Categorical outcomes were added, and percents were expressed relative to total number of surgeries (n = 38,764).

resultsSimultaneous BTKA had longer LOS (5.0 days ± 4.7 vs. 4.5 days ± 3.5; p < 0.001), higher non-home discharge [36.9% (n = 7150/19,382) vs. 13.6% (n = 5451/38,764)], in-hospital periprosthetic fractures [0.13% (26/19,382) vs. 0.08% (31/38,764); p = 0.049], any non-mechanical complication [33.76% (6543/19,382) vs.15.93% (6177/38,764); p < 0.0001], hematoma/seroma formation [0.11% (22/19,382) vs. 0.05% (20/38,764); p = 0.0088], wound disruption [0.08% (16/19,382) vs. 0.04% (16/38,764); p = 0.0454], and any infection [1.13% (219/19,382) vs. 0.50% (194/38,764); p < 0.0001]. Average in-hospital costs for the two staged BTKA episodes combined were $5006 higher than those of simultaneous BTKA ($28,196 ± $18,488 vs. $33,202 ± $15,240; p < 0.001).

conclusionSimultaneous BTKA had higher healthcare utilization and in-hospital complications than both episodes of staged BTKA combined, with a minimal in-hospital cost savings. Future studies are warranted to further explore patient selection who would benefit from BTKA.

Indexed as

Arthroplasty, Replacement, KneePeriprosthetic FracturesHospital CostsHumansLength of StayPostoperative ComplicationsPropensity ScoreRetrospective StudiesTreatment OutcomeBilateral total knee arthroplasty (TKA)ComplicationsCostNationalOutcomesReadmission

Identifiers

PMID35377079

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.