AccScience Publishing / OTE / Volume 1 / Issue 1 / DOI: 10.36922/ote.6662
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ORIGINAL RESEARCH ARTICLE

Post-operative pulmonary complications in total knee arthroplasty: Incidence, risk factors, and impact on patient outcomes

Xinlin Huang1† ,  Bofei Dong1† ,  Zhaofeng Liu1† ,  Junhao Lin2 ,  Pengcheng Gao3 ,  Lei Fan4* ,  Jian Wang4*
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1 The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
2 School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China
3 School of Laboratory Medicine and Biotechnology, Southern Medical University, Guangzhou, Guangdong, China
4 Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
†These authors contributed equally to this work.
OTE 2025, 1(1), 6662 https://doi.org/10.36922/ote.6662
Received: 28 November 2024 | Revised: 14 February 2025 | Accepted: 27 February 2025 | Published online: 19 March 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Post-operative pulmonary complications (PPCs) after total knee arthroplasty (TKA) are a significant cause of morbidity and mortality, prolonging hospital stays and increasing healthcare costs. Identifying risk factors for PPCs is crucial for developing targeted preventive strategies. This study aimed to systematically analyze the incidence of PPCs and their impact on patient outcomes following TKA, with a focus on identifying specific risk factors associated with PPCs. Utilizing the National Inpatient Sample (NIS) database, we identified 550,168 TKA cases between 2016 and 2019. PPCs were defined based on International Classification of Diseases, 10th Revision, Clinical Modification codes, including pneumonia, pulmonary embolism (PE), and acute respiratory failure. We evaluated patient demographics, payer type, hospital costs, perioperative complications, and length of stay. Multivariate logistic regression analysis was performed to identify relevant independent risk factors; the overall incidence of PPCs was 0.78%, with pneumonia at 0.21%, acute respiratory failure at 0.44%, and PE at 0.22%. Patients with PPCs were older (median age 70 years vs. 67 years) and had a higher proportion of comorbidities. Key risk factors identified included older age (odds ratio [OR] = 1.21), female gender (OR = 1.10), chronic pulmonary disease (OR = 1.47), coagulopathy (OR = 1.67), and post-operative complications such as deep vein thrombosis (OR = 9.41) and acute renal failure (OR = 8.07). PPCs were linked to a notably extended median duration of hospitalization (5 days compared to 2 days), elevated median healthcare costs ($81,829 compared to $53,542), and a higher mortality rate (2.5% compared to 0.0%). PPCs following TKA impose significant financial and healthcare challenges. These results underscore the critical role of thorough pre-operative risk evaluation and effective post-operative care in mitigating the occurrence of PPCs. This research offers evidence-based guidance to support clinical decision-making and enhance patient outcomes after TKA.

Keywords
Arthroplasty
Replacement
Knee
Post-operative pulmonary complications
Risk factors
Funding
This work was supported by the National Natural Science Foundation of China Youth Fund (grant number 82202662, 2022), the China Postdoctoral Science Foundation (grant number 2024T170380, 2024), the Natural Science Foundation of Guangdong Province of China (grant number 2024A1515012767, 2024), and the Guangzhou Science and Technology Planning Project (grant number 2023A04J2314, 2023).
Conflict of interest
Lei Fan is the Editorial Board Member of this journal but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.
References
  1. Canovas F, Dagneaux L. Quality of life after total knee arthroplasty. Orthop Traumatol Surg Res. 2018;104(1):S41-S46. doi: 10.1016/j.otsr.2017.04.017

 

  1. Dubin JA, Bains SS, Paulson AE, et al. The current epidemiology of revision total knee arthroplasty in the United States from 2016 to 2022. J Arthroplasty. 2024;39(3):760-765. doi: 10.1016/j.arth.2023.09.013

 

  1. Venishetty N, Wukich DK, Beale J, et al. Total knee arthroplasty in dialysis patients: A national in-patient sample-based study of perioperative complications. Knee Surg Relat Res. 2023;35(1):22. doi: 10.1186/s43019-023-00196-0

 

  1. Huang L, Huang X, Lin J, Yang Q, Zhu H. Incidence and risk factors of postoperative pulmonary complications following total hip arthroplasty revision: A retrospective nationwide inpatient sample database study. J Orthop Surg Res. 2024;19(1):353. doi: 10.1186/s13018-024-04836-3

 

  1. Moldovan F. Bone cement implantation syndrome: A rare disaster following cemented hip arthroplasties-clinical considerations supported by case studies. J Pers Med. 2023;13(9):1381. doi: 10.3390/jpm13091381

 

  1. Chandler D, Mosieri C, Kallurkar A, et al. Perioperative strategies for the reduction of postoperative pulmonary complications. Best Pract Res Clin Anaesthesiol. 2020;34(2):153-166. doi: 10.1016/j.bpa.2020.04.011

 

  1. Diaz-Fuentes G, Hashmi HRT, Venkatram S. Perioperative evaluation of patients with pulmonary conditions undergoing non-cardiothoracic surgery. Health Serv Insights. 2016;9(Suppl 1):9-23. doi: 10.4137/HSI.S40541

 

  1. Loeffelbein DJ, Julinek A, Wolff KD, Kochs E, Haller B, Haseneder R. Perioperative risk factors for postoperative pulmonary complications after major oral and maxillofacial surgery with microvascular reconstruction: A retrospective analysis of 648 cases. J Craniomaxillofac Surg. 2016;44(8): 952-957. doi: 10.1016/j.jcms.2016.05.007

 

  1. Rajaee SS, Campbell JC, Mirocha J, Paiement GD. Increasing burden of total hip arthroplasty revisions in patients between 45 and 64 years of age. J Bone Joint Surg Am. 2018;100(6):449-458. doi: 10.2106/JBJS.17.00470

 

  1. Haines KL, Agarwal S. Postoperative pulmonary complications-A multifactorial outcome. JAMA Surg. 2017;152(2):166. doi: 10.1001/jamasurg.2016.4102

 

  1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242(3):326- 341; discussion 341-343. doi: 10.1097/01.sla.0000179621.33268.83

 

  1. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338-1350. doi: 10.1097/ALN.0b013e3181fc6e0a

 

  1. Yücel MO, Sağlam S, Dalaslan RE, et al. Significance of preoperative multidisciplinary assessment with 30-second sit-to-stand and timed up-and-go tests in predicting postoperative outcomes. J Clin Med. 2025;14(4):1085. doi: 10.3390/jcm14041085

 

  1. Katsura M, Kuriyama A, Takeshima T, Fukuhara S, Furukawa TA. Preoperative inspiratory muscle training for postoperative pulmonary complications in adult patients undergoing cardiac and major abdominal surgery. Cochrane Database Syst Rev. 2013. doi: 10.1002/14651858.CD010356

 

  1. McMurray JJ, Pfeffer MA. Heart failure. Lancet. 2005;365(9474):1877-1889. doi: 10.1016/S0140-6736(05)66621-4

 

  1. Kim M, Li G. Postoperative complications affecting survival after cardiac arrest in general surgery patients. Anesth Analg. 2018;126(3):858-864. doi: 10.1213/ANE.0000000000002460

 

  1. Chung JJ, Dolan MT, Patetta MJ, DesLaurier JT, Boroda N, Gonzalez MH. Abnormal coagulation as a risk factor for postoperative complications after primary and revision total hip and total knee arthroplasty. J Arthroplasty. 2021;36(9):3294-3299. doi: 10.1016/j.arth.2021.04.024

 

  1. Boc A, Vene N, Štalc M, Košmelj K, Mavri A. Unprovoked proximal venous thrombosis is associated with an increased risk of asymptomatic pulmonary embolism. Thromb Res. 2014;133(6):1011-1015. doi: 10.1016/j.thromres.2014.02.033

 

  1. Clark A, Tawhai M. Pulmonary vascular dynamics. Compr Physiol. 2019;9:1081-1100. doi: 10.1002/cphy.c180033

 

  1. Stollings JL, Kotfis K, Chanques G, Pun BT, Pandharipande PP, Ely EW. Delirium in critical illness: Clinical manifestations, outcomes, and management. Intensive Care Med. 2021;47(10):1089-1103. doi: 10.1007/s00134-021-06503-1

 

  1. Mashour GA, Woodrum DT, Avidan MS. Neurological complications of surgery and anaesthesia. Br J Anaesth. 2015;114(2):194-203. doi: 10.1093/bja/aeu296

 

  1. Malcolm TL, Knezevic NN, Zouki CC, Tharian AR. Pulmonary complications after hip and knee arthroplasty in the United States, 2004-2014. Anesth Analg. 2020;130(4): 917-924. doi: 10.1213/ANE.0000000000004265

 

  1. Piper GL, Kaplan LJ. Fluid and electrolyte management for the surgical patient. Surg Clin North Am. 2012;92(2):189- 205, vii. doi: 10.1016/j.suc.2012.01.004

 

  1. Dexter AM, Scott JB. Airway management and ventilator-associated events. Respir Care. 2019;64(8):986-993. doi: 10.4187/respcare.07107

 

  1. Sloan M, Lee GC. Mortality and complications in patients with metastatic disease after primary total hip and total knee arthroplasty. J Arthroplasty. 2020;35(12):3512-3516. doi: 10.1016/j.arth.2020.06.080

 

  1. Turan A, Yang D, Bonilla A, et al. Morbidity and mortality after massive transfusion in patients undergoing non-cardiac surgery. Can J Anesth. 2013;60(8):761-770. doi: 10.1007/s12630-013-9937-3
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