Association between rehabilitation timing and major complications of total knee arthroplatsy.
ABSTRACT To investigate the association between rehabilitation timing and the occurrence of post-total knee arthroplasty complications and related medical service utilization.
Data from Taiwan's National Health Insurance Research Database from 2003-2006 were used to perform a retrospective study on patients who received their initial total knee arthroplasty during 2004-2005 (a total of 21,143 subjects). All subjects were divided into 1 of 3 groups based on the timing of their rehabilitation after total knee arthroplasty, namely, the within 2 weeks group, the after 2 weeks group or the no-rehabilitation group.
We found that patients in the no-rehabilitation group and the after 2 weeks group had higher incidences of prosthetic infection (odds ratio (OR) =1.29, p=0.0409; OR=1.66, p=0.0012) and deep venous thrombosis (OR=1.51, p=0.0099; OR=2.07; p=0.0007) than in the within-2-weeks group. In addition, compared with the within-2-weeks group, the after 2 weeks group had higher total medical expenses (exponentiated regression coefficient: Exp. (β) =1.07, p=0.0211), and the no-rehabilitation group had lower total medical expenses (Exp. (β) =0.01, p<0.0001).
The results of this study indicated that, because the incidence rates of complications and medical service utilization among total knee arthroplasty patients in the within 2 weeks group were lower than in the after 2 weeks group, the timing of rehabilitation may be 1 factor affecting post-TKA complications and promoting high levels of medical service utilization. These findings could be useful for clinicians and health policymakers attempting to improve total knee arthroplasty services.
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ABSTRACT: The purpose of this study was to examine the effect of preoperative comorbidities on the risk of VTE after joint arthroplasty surgery. Of 2235 citations identified for screening, 16 studies reporting 7,395,847 patients were eligible. The results showed that patients with cardiovascular disease, previous VTE history, neurologic disease and high anesthetic ASA rating had significantly higher VTE risk than those with no such preexisting medical comorbidities after joint arthroplasty. The presence of respiratory disease, urinary and kidney disease, coronary artery disease, endocrine disease, cancer and malignant disease, hematological disease and comorbidities index did not increase the risk of VTE in our study. The data suggest that risk assessment of patients may further reduce the overall incidence of DVT and PE from VTE prophylaxis.The Journal of arthroplasty. 05/2014;