Presentation Abstract

Session: 766-780-Adult Reconstruction Hip VII
Date/Time: Friday, Mar 22, 2013, 5:24 PM - 5:30 PM
Location McCormick Place, Room S105
Presentation Number: Paper 777
Title: Prospective Study of Unplanned Admission to the Intensive Care Unit after Total Hip Arthroplasty
Classification: +Complications (Hip)
Keywords: Complications; Total Hip Arthroplasty; Outcomes; Economic / Cost Analysis; Quality Control
Author(s): Atul F. Kamath, MD, Rochester, Minnesota
Jacob T. Gutsche, MD, Philadelphia, Pennsylvania
Laura Kosseim, MD, Philadelphia, Pennsylvania
Zev N. Kornfield, MD, Philadelphia, Pennsylvania
Keith D. Baldwin, MD, Sicklerville, New Jersey
Craig L. Israelite, MD, Philadelphia, Pennsylvania
Abstract: INTRODUCTION: Triage to the intensive care unit (ICU) after elective total hip arthroplasty (THA) proves a complex medical and resource decision point. We sought to prospectively test our model of pre-operative risk stratification at a tertiary, high-volume arthroplasty center.
METHODS: A total of 175 consecutive patients were triaged to either an ICU bed or routine post-operative floor according to established ICU admission criteria. Threshold for ICU triage was ≥2 risk factors: age >75 years, revision surgery, creatinine clearance <60mL/min or BMI>35. These factors were established from a prior retrospective study of 1,259 consecutive THA patients. Primary endpoints were a reduction in unplanned admission to the ICU, as well as mortality and major complications. A pre-study power analysis demonstrated adequate patient numbers. Costs per patient were calculated.
RESULTS: All patients were prospectively triaged and followed during the study period. After implementation of our triage model, the rate of unplanned ICU admissions dropped from 7.1% to 2.2% (p=0.013). In an intent-to-treat analysis, the unplanned admission rate was 0.6% (p<0.001). Likewise, the major complication rate fell from 12.5% to 2% with intervention. There was only a modest (11.4% from 7.1%) total increase in number of ICU admits. The as-treated odds of unplanned admission pre- versus post-intervention was 3.2 (1.2, 10.6).
DISCUSSION AND CONCLUSION: Pre-operative triage to the ICU according to selected risk factors affects a reduction in post-operative unplanned ICU admissions and major complications after elective total hip arthroplasty.

Disclosures: Presenting Author
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Author 2
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Author 4
4 - Pfizer; 7 - Journal of Bone and Joint Surgery - American
Author 5
3B - Zimmer



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