A comment from the US of A on bilateral TKR that has just been published:
[FONT="]Increased odds of complications seen with simultaneous bilateral vs. unilateral TKA [/FONT]
[FONT="]SAN FRANCISCO — A study using a national inpatient sample database to identify broken link removed: https://www.orthosupersite.com/searchResults.aspx?partialfields=&cx=&q=total%20knee%20arthroplasties&client=common_frontend&output=xml_no_dtd&proxystylesheet=common_frontend&getfields=MediaType.PostedDate&filter=0&sort=date&requiredfields=projectID%3A19&site=default_collection&x=9&y=2total%20knee%20arthroplasties found that simultaneous broken link removed: https://www.orthosupersite.com/searchResults.aspx?partialfields=&cx=&q=bilateral%20knee%20arthroplasty&client=common_frontend&output=xml_no_dtd&proxystylesheet=common_frontend&getfields=MediaType.PostedDate&filter=0&sort=date&requiredfields=projectID%3A19&site=default_collection&x=9&y=2bilateral%20knee%20arthroplasty procedures are associated with significantly higher odds of inhospital complications and mortality compared with broken link removed: https://www.orthosupersite.com/searchResults.aspx?partialfields=&cx=&q=unilateral%20knee%20arthroplasty&client=common_frontend&output=xml_no_dtd&proxystylesheet=common_frontend&getfields=MediaType.PostedDate&filter=0&sort=date&requiredfields=projectID%3A19&site=default_collection&x=9&y=2unilateral%20knee%20arthroplasty procedures. [/FONT]
[FONT="]“The literature to date on this topic has been conflicting, mainly because we lack a true level 1 randomized study, and most studies from a single center lack the sufficient power to show relatively small differences,” Bryan D. Springer, MD, said at the broken link removed: https://www.orthosupersite.com/setContent.aspx?sid=1224, here. “But this nation-wide, inpatient sample of over 400,000 patients found that bilateral simultaneous total knee arthroplasty has greater odds of complications including mortality, and that demographics, health status, payer type and hospital type are all significant factors in the complication rates.” [/FONT]
[FONT="]He added, “It is important to keep in mind, however, that overall complication rates in both groups are low and patients who face unilateral complications risk twice if they are considering staged operations, and such factors need to be considered by surgeons and patients during the decision making process.” [/FONT]
[FONT="]Springer and Susan M. Odum studied 382,496 unilateral total knee arthroplasties (TKAs) and 24,574 simultaneous bilateral procedures. They used ICD-9 codes to identify the incidence of complications. They also reviewed patient demographics, comorbidities, payor type and the type of hospital in which the TKA was performed. [/FONT]
[FONT="]A bivariate analysis revealed that simultaneous bilateral TKA had increased odds of mortality, and minor and major complications compared to unilateral TKA. After adjusting for covariates, the investigators also found that simultaneous bilateral TKA had higher odds of mortality and complications compared with unilateral TKA. [/FONT]
[FONT="]In addition, the research showed that men had lower odds of all complications compared to women. Using Caucasians as a reference group, the investigators found that other races and ethnicities had higher odds of minor complications. Patients with private insurance and Medicaid had a slightly increased risk of minor complications compared with Medicare patients, and procedures performed at urban nonteaching hospitals had lower odds of minor and major complications compared to teaching facilities. Morality was the highest in a rural nonteaching hospital. [/FONT]
[FONT="]“The details and difficulties of the procedures are difficult to ascertain, and we lack unique identifiers that some of these unilateral total knees may, in fact, have been staged unilateral total knees done over a period of time,” Springer said. [/FONT]
[FONT="]Reference: [/FONT][FONT="][/FONT]
· [FONT="]Odum SM, Springer BD. Factors associated with perioperative complication rates after unilateral vs. simultaneous TKA. Paper #3. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.[/FONT]
· [FONT="]Disclosure:[/FONT][FONT="] Springer receives speakers’ bureau/paid presentations from DePuy, and is a paid consultant for Stryker and Convatec Surgical. [/FONT]
United Kingdom
thank you.
:happy dance:
Judy
