From Our 2012 Archives

Obesity, Diabetes May Raise Complications After Joint Replacement

THURSDAY, June 7 (HealthDay News) -- About 3 percent of patients who have total hip and knee replacements require critical care services before they leave the hospital, a large new study indicates.

The findings highlight the risks of these elective surgeries in older patients with other health problems and show that the procedures are placing an increasing burden on the health care system's critical care services, according to the study authors.

In the study, published online and in the July print issue of the journal Anesthesiology, researchers analyzed data from nearly 530,000 patients who had total knee or hip replacement surgery at 400 U.S. hospitals between 2006 and 2010.

Compared to patients who didn't require follow-up critical care services, the 3 percent of patients who did require such care had a higher death rate (2.5 percent versus 0.1 percent), longer hospitals stays, higher costs and were less likely to go home after being discharged (40 percent versus 63 percent), the investigators found.

In addition, the researchers noted that older patients (average age 69) were more likely to require critical care services than younger patients (average age 66). Patients who needed critical care services were also more likely to have other health problems such as obesity, diabetes and chronic obstructive pulmonary [lung] disease.

Heart and lung problems were the most common complications that led to the use of critical care services following total knee or hip replacement. The need for critical care services was also higher among patients who had general anesthesia rather than spinal anesthesia.

The findings show that the percentage of total knee and hip joint replacement patients who require critical care services is large enough that hospitals and critical care doctors need to prepare for the growing number of these patients who will require such care, said lead author Dr. Stavros Memtsoudis, director of critical care services at the Hospital for Special Surgery, in New York City.

"Orthopedic patients are not the prime type of patient that people expect in an [intensive care unit]. It is elective surgery after all," Memtsoudis said in a hospital news release. "Risk factors for needing critical care services are advanced age and existing coronary artery disease, diabetes, obesity and a number of other [preexisting conditions]. Unfortunately, this is the type of population that usually requires hip and knee replacements."

Currently, more than one million hip and knee replacements are performed each year in the United States, the release noted. That number is expected to be more than 4 million by 2030.

-- Robert Preidt

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SOURCE: Hospital for Special Surgery, news release, June 5, 2012