The Impact of Hospital Exposures Prior to Total Knee Arthroplasty on Postoperative Outcomes

Background: Total knee arthroplasty (TKA) procedures are expected to grow exponentially in the upcoming years, highlighting the importance of identifying preoperative risk factors that predispose patients to poor outcomes. The present study sought to determine if preoperative healthcare events (PHEs) influenced outcomes following TKA.

Methods: This was a retrospective review of all patients who underwent TKA at a single institution from June 2011 to April 2022. Patients who had a PHE within 90 days of surgery, defined as an emergency department visit or hospital admission, were compared to patients with no history of PHE. Patients who underwent revision, nonelective, and/or bilateral TKA were excluded. Chi-squared analysis and independent sample t-tests were used to determine significant differences between demographic variables. All significant covariates were included in binary logistic regressions used to predict discharge disposition, 90-day readmission, and 1-year revision.

Results: Of the 10,869 patients who underwent TKA, 265 had ≥1 PHE. Patients who had a PHE were significantly more likely to require facility discharge (odds ratio [OR]: 1.662; P = .001) than patients who did not have a PHE. Any PHE predisposed patients to significantly higher 90-day readmission rates (OR: 2.173; P = .002). Patients with ≥2 PHEs were at a significantly higher risk of 1-year revision (OR: 5.870; P = .004) compared to patients without a PHE.

Conclusions: Our results demonstrate that PHEs put patients at significantly greater risk of facility discharge, 90-day readmission, and 1-year revision. Moving forward, consideration of elective surgery scheduling in the context of a recent PHE may lead to improved postoperative outcomes.

Level iii evidence: Retrospective Cohort Study.