Chronic Obstructive Pulmonary Disease Is Associated With Higher Rates of Venous Thromboemboli Following Primary Total Knee Arthroplasty

• Published in: The Journal of arthroplasty 2020-08, Vol.35 (8), p.2066-2071.e9
• Main Authors: Vakharia, Rushabh M., Adams, Curtis T., Anoushiravani, Afshin A., Ehiorobo, Joseph O., Mont, Michael A., Roche, Martin W.
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee - adverse effects; chronic obstructive pulmonary disease; costs; Humans; Length of Stay; medicare; Patient Readmission; Postoperative Complications; Pulmonary Disease, Chronic Obstructive - complications; Pulmonary Disease, Chronic Obstructive - epidemiology; readmissions; Retrospective Studies; Risk Factors; total knee arthroplasty; United States; venous thromboemboli; Venous Thromboembolism - epidemiology; Venous Thromboembolism - etiology
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.03.053

There is discordance in the literature regarding the presence of chronic obstructive pulmonary disease (COPD) and the development of venous thromboemboli (VTEs). Therefore, the purpose of this study is to determine whether COPD patients undergoing primary total knee arthroplasty (TKA) have higher rates of (1) in-hospital lengths of stay (LOS); (2) readmissions; (3) VTEs; and (4) costs of care. COPD patients undergoing primary TKA were identified and matched to controls in a 1:5 ratio by age, gender, and medical comorbidities. Patients with a history of VTEs or hypercoagulable states were excluded. The query yielded 211,378 patients in the study (n = 35,230) and control (n = 176,148) cohorts. Outcomes analyzed included in-hospital LOS, readmission rates, VTEs, and costs of care. A P-value less than .01 was considered statistically significant. COPD patients were found to have significantly longer in-hospital LOS (4 vs 3 days, P < .0001). Study group patients were also found to have significantly higher incidence and odds ratio (OR) of readmission rates (20.9% vs 16.3%; OR 1.36, P < .0001) and VTEs (1.75 vs .93; OR 1.18, P < .0001). Additionally, the study demonstrated that COPD patients incurred higher 90-day episode-of-care costs ($15,626.85 vs $14,471.29, P < .0001). After adjusting for confounding variables, our study found an association between COPD and higher rates of developing VTEs following primary TKA. The study can be used by orthopedic surgeons to adequately counsel and educate these patients of the potential complications which may arise following their TKA.