Utilization of Critical Care Services among Patients Undergoing Total Hip and Knee Arthroplasty: Epidemiology and Risk Factors

Background: A paucity of data exist on the use of critical care services (CCS) among hip and knee arthroplasty patients. The authors sought to identify the incidence and risk factors for the use of CCS among these patients and compare the characteristics and outcomes of patients who require CCS to those who do not. Methods: The authors analyzed hospital discharge data of patients who underwent primary hip or knee arthroplasty in approximately 400 United States hospitals between 2006 and 2010. Patient and healthcare system-related demographics for admitted patients requiring CCS were compared with those who did not. Differences in outcomes, including mortality, complications, disposition status, and hospital charges, were analyzed. Regression analysis was performed to identify risk factors for requiring CCS. Results: A total of 528,495 patients underwent primary total hip (n = 172,467, 33%) and knee arthroplasty (n = 356,028, 67%). Of these, 3% required CCS. On average, CCS patients were older and had a higher comorbidity burden than did patients not requiring CCS. CCS patients experienced more complications, had longer hospital stays and higher costs, and were less likely to be discharged home than were non-CCS patients. Risk factors with increased odds for requiring CCS included advanced age, use of general versus neuraxial anesthesia, and the presence of postoperative cardiopulmonary complications. Conclusions: Approximately 1 of 30 patients undergoing total joint arthroplasty requires CCS. Given the large number of these procedures performed annually, anesthesiologists, orthopedic surgeons, critical care physicians, and administrators should be aware of the attendant risks this population represents and allocate resources accordingly.