Abstract
BackgroundElective total knee arthroplasty (TKA) is a common surgery which has evolved rapidly. However, there are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved.MethodsTo obtain a pooled estimate of SAE rate and 30-dRR following TKA, we searched Medline, Web of Science, Cochrane Library, and Google Scholar databases. Data were extracted by two authors following PRISMA guidelines. Eligibility criteria were defined prior to a comprehensive search. Studies were eligible if they were published in 2007 or later, described sequelae of TKA with patient N > 1000, and the SAE or 30-dRR rate could be calculated. SAEs included return to operating room, death or coma, venous thromboembolism (VTE), deep infection or sepsis, myocardial infarction, heart failure or cardiac arrest, stroke or cerebrovascular accident, or pneumonia.ResultsOf 248 references reviewed, 28 are included, involving 10,153,503 patients; this includes 9,483,387 patients with primary TKA (pTKA), and 670,116 patients with revision TKA (rTKA). For pTKA, the SAE rate was 5.7% (95% CI 4.4−7.2%, I2 = 100%), and the 30-dRR was 4.8% (95% CI 4.3−5.4%, I2 = 100%). For rTKA, the SAE rate was 8.5% (95% CI 8.3−8.7%, I2 = 77%), while the 30-dRR was 7.2% (95% CI 6.4−8.0%, I2 = 81%). Odds of 30-dRR following pTKA were about half that of rTKA (OR 0.57, 95% CI 0.53−0.62%, p < 0.001, I2 = 45%). Of patients who received pTKA, the commonest SAEs were VTE (1.22%; 95% CI 0.83−1.70%) and genitourinary complications including renal insufficiency or renal failure (1.22%; 95% CI 0.83−1.67%). There has been significant improvement in SAE rate and 30-dRR since 2010 (χ2 test < 0.001).ConclusionsTKA procedures have a relatively low complication rate, and there has been a significant improvement in SAE rate and 30-dRR over the past decade.
Highlights
Serious adverse events (SAEs) can be an indicator of therapeutic failure or declining patient health and are costly to the medical system [1]
The emphasis on characterizing healthcare quality has resulted in a spate of recent papers that have assessed the serious adverse event (SAE) rate and the 30-day readmission rate (30-dRR) for total knee arthroplasty, these analyses often include fewer than 10,000 patients [6–8]
Three additional records were identified through the electronic search of other electronic databases, while 4 records were found through a manual search of relevant bibliographies
Summary
Serious adverse events (SAEs) can be an indicator of therapeutic failure or declining patient health and are costly to the medical system [1]. The Affordable Care Act in the USA mandated reporting of SAEs and established the 30-day readmission rate (30-dRR) as an important metric [4]. The emphasis on characterizing healthcare quality has resulted in a spate of recent papers that have assessed the SAE rate and the 30-dRR for total knee arthroplasty, these analyses often include fewer than 10,000 patients [6–8]. Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for primary total knee arthroplasty (pTKA) for the years from 2011 to 2013, the SAE rate was 1.4% among 65,694 patients [6], while the 30dRR was 3.5% among 6790 patients [7]. There are no recent large systematic reviews of serious adverse event (SAE) rate and 30-day readmission rate (30-dRR) or an indication of whether surgical methods have improved
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