Patients receiving hip replacement devices or knee implants may face a more complicated recovery if they are obese, or suffer from diabetes or other health woes. According to a new study published online in the journal Anesthesiology, at least 3% of all total hip or knee replacement patients will require critical care before they leave the hospital, and in most cases, it is a patient’s pre-existing health problems that make their recovery more difficult.
According to U.S. News & World Report, more than one million hip and knee replacements are performed each year in the U.S. However, that number is expected to be more than 4 million by 2030. Older patients, a population more likely to suffer from coronary artery disease, diabetes, obesity and a number of other pre-existing health problems, are common candidates for these procedures.
For the Anesthesiology study, 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. The 3% of patients who needed critical care in the days after their surgery were more likely to suffer from other health problems such as obesity, diabetes and chronic obstructive pulmonary [lung] disease. They also tended to be older, with an average age of 69.
The most common complications seen among these patients included heart problems, including heart attack, and pulmonary compromise. Clinically, pulmonary compromise can range from shortness of breath to acute respiratory distress syndrome (ARDS), the latter of which associated with a high risk of death. While any surgery is stressful on the heart, especially in older patients, joint replacement surgery carries a special risk for pulmonary compromise because of the very nature of implanting and cementing a prostheses, according to the study authors.
The study also found that patients needing critical care services post-surgery had worse outcomes compared to those who did not. The study found these patients had a higher death rate (2.5 percent versus 0.1 percent), stayed in the hospital longer, cost more to treat, and were less likely to go home after being discharged (40 percent versus 63 percent).
Dr. Stavros Memtsoudis, lead author of the study, and director of critical care services at the Hospital for Special Surgery, in New York City, said in a news release that hospitals should be prepared to deliver critical care services to hip replacement and knee implant patients who suffer from pre-existing health problems.
“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. “Risk factors for needing critical care services are advanced age and existing coronary artery disease, diabetes, obesity and a number of other [preexisting conditions].
The researchers recommend that hospitals increase surveillance of high-risk patients undergoing hip and knee replacement surgery. Two years ago, the Hospital for Special Surgery established a team of six critical care physicians to attend to the critical care needs of their orthopedic patients. Now, high-risk patients undergoing joint replacement surgery at the facility receive more specialized levels of care.