Predictors of the need for critical care after total joint arthroplasty: an update of our institutional risk stratification model

J Arthroplasty. 2014 Jul;29(7):1350-4. doi: 10.1016/j.arth.2014.02.028. Epub 2014 Mar 1.

Abstract

Based on our previously published risk stratification model, 295 (19%) of a consecutive series of 1594 TJA patients were triaged to the ICU. However, only 67 patients (22%) required intensive care interventions. We identified 5 independent multivariate predictors (P < 0.001) including COPD, CAD, CHF (1 point each), EBL > 1000 mL, and intraoperative vasopressors (2 points each) to form the Penn Arthroplasty Risk Score (PARS). Patients with a score of 0 through 7 had a probability of requiring critical care of 7.0%, 13.2%, 23.5%, 38.1%, 55.4%, 71.4%, 83.4%, and 91.1% respectively. Based on these results, our previous risk stratification protocol is overly sensitive and non-specific. Any risk stratification algorithm for ICU admission should include intraoperative risk factors in order to be fully predictive.

Keywords: complications; intensive care unit; risk stratification; total joint arthroplasty.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Arthroplasty
  • Arthroplasty, Replacement, Hip / methods*
  • Arthroplasty, Replacement, Knee / methods*
  • Critical Care / organization & administration*
  • Female
  • Humans
  • Intensive Care Units*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • ROC Curve
  • Risk Factors