Abstract Perspective: Serious adverse events and 30-day hospital readmission rate following elective total knee arthroplasty: A systematic review and meta-analysis

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Total knee arthroplasty (TKA)—knee replacement surgery—is a common procedure that may be used inappropriately.  Patients may opt for premature TKA because of unrealistic expectations of positive outcomes, undervaluation of the risk of negative outcomes, and lack of knowledge about competing treatments.  The Affordable Care Act mandated reporting of serious adverse events (SAEs) and established 30-day readmission rate (30-dRR) as an important metric, but most reviews involve relatively few patients.  To obtain an accurate estimate of SAEs and the 30-dRR associated with TKA, we pooled data from 28 published papers, which together included >10 million patients.  SAEs evaluated were:  return to operating room; death or coma; venous thromboembolism (VTE); deep infection or sepsis; myocardial infarction; heart failure or cardiac arrest; stroke or cerebrovascular accident; or pneumonia.  For primary TKA, the SAE rate was 5.7%, and the 30-dRR was 4.8%.  For revision TKA, the SAE rate was 8.5%, while the 30-dRR was 7.2%.  There has been significant improvement in SAEs and 30-dRR since 2010, but TKA has a non-negligible complication rate, more pronounced in revision surgery.  Postponing surgery until no revision is likely limits medical costs and may make sense for the patient, provided that effective symptomatic relief is offered.

– Study author R. Grant Steen, PhD