Study: Patients with prior pulmonary embolism required further care after TJA
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Key takeaways:
- Patients with a prior history of pulmonary embolism had worse outcomes after TJA vs. patients without such history.
- Patients with pulmonary embolism may often require additional postoperative care.
Patients with a history of pulmonary embolism prior to total hip or total knee arthroplasty may be at increased risk for postoperative complications and longer hospital stays, according to published results.
Researchers from the Northwestern University Feinberg School of Medicine retrospectively reviewed data from 75 patients who underwent TKA and 102 patients who underwent THA with a prior history of pulmonary embolism (PE). Researchers compared data with matched cohorts of 249 patients who underwent TKA and 282 patients who underwent THA without a prior history of PE.
According to the study, outcome measures included complications, length of stay (LOS), readmission and incidence of postoperative PE.
Patients who underwent TKA with prior history of PE were more likely to have longer LOS (3.2 vs. 2.3 days), readmission within 30 days (13.3% vs. 2.8%), complications (25.3% vs. 2.1%) and postoperative PE (17.3% vs. 0%) compared with patients without a prior history of PE. Similarly, patients who underwent THA with prior history of PE were more likely to have longer LOS (3.3 vs. 2.1 days), complications (14.7% vs. 1.7%) and postoperative PE (9.8% vs. 0.4%) compared with patients without a prior history of PE.
“Our findings indicate that patients undergoing TJA who had a prior PE are at higher risk of requiring postoperative care,” the researchers wrote in the study. “Therefore, thorough preoperative evaluation must be implemented prior to surgery, especially in clinical environments that do not possess resources for acute escalation of care,” they concluded.
Perspective
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This study by Christopher Reynolds, BS, and colleagues shows patients undergoing THA or TKA with a history of PE have substantially elevated rates of complications, postoperative PE (nearly 20 times higher) and longer hospital stays. Prior studies have shown patients at highest risk for postoperative venous thromboembolism (VTE) are those patients with a history of VTE, and this study reinforces that notion.
The relatively good news from this study is that complication rates appear to be dropping over time, with 2020 to 2021 showing one-half (TKA) to one-third (THA) the complication rates from 2012 to 2013. I would posit that this is due to the move toward earlier mobilization and more rapid ambulation and discharge, maybe the strongest deterrent to VTE. While it may be counterintuitive, I would argue this supports the move toward same-day discharge, even for these higher-risk patients, where patients are more likely to move compared to being confined to a hospital bed.
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