Does admission to intensive care post total joint arthroplasty result in poorer outcomes 12-months after surgery?

Background: It is unknown if total joint arthroplasty (TJA) patients admitted to the intensive care unit (ICU) benefit from the surgery. This impedes clinical decision-making, resource allocation and patient informed consent. This study aims to identify whether admission to ICU post-TJA surgery is associated with poorer quality of life, pain and function, compared to those not requiring ICU admission.

Methods: Data on patients who underwent elective total hip or knee arthroplasty between 2006 and 2019 were extracted from a single-institution registry in Melbourne, Australia. Adjusted mixed-linear regression models were used to estimate the mean difference at 12 months in quality of life (VR-12), and pain and function (WOMAC) between patients admitted postoperatively to ICU and those not admitted.

Results: Of the 8444 patients that met the study inclusion criteria, 128 (1.5%) patients were admitted to ICU peri- or postoperatively. The median length of stay in ICU was 1 day (IQR = 1). Patients in both groups reported similar clinically meaningful improvements in quality of life, pain and function 12-months after surgery.

Conclusion: Clinicians weighing up risks versus benefits of TJA in patients with a higher risk of ICU admission should not overlook the significant improvements in quality of life, pain and function likely to be seen.