Abstract
Purpose
Triage to the intensive care unit (ICU) after elective total hip arthroplasty (THA) proves a complex medical and resource decision point. This study tested a model of pre-operative risk stratification at a tertiary, high-volume arthroplasty centre.
Methods
175 consecutive THA patients were prospectively triaged to either an ICU bed or routine post-operative floor according to admission criteria based on a prior study of 1259 THA patients. The threshold for ICU admission was >=2 risk factors: age >75 years, revision surgery, creatinine clearance <60 mL/min, prior myocardial infarction, and/or BMI >35. Primary endpoints were a reduction in unplanned admission to the ICU, as well as major complications. A pre-study power analysis demonstrated adequate patient numbers.
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). The as-treated odds of unplanned admission pre-versus post-intervention were 3.2 (1.2, 10.6). In an intent-to-treat analysis, the unplanned admission rate was 0.6% (p<0.001). The major complication rate fell from 12.5% to 2% with intervention, and the mortality index decreased from 4.77 to 1.62. There was only a modest increase in the total number of ICU admits (11.4% post-intervention).
Conclusions
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 joint arthroplasty.
