Total Knee Replacement (TKR): Audit of readmissions within 30 days

Title : Total Knee Replacement (TKR): Audit of readmissions within 30 days

Abstract:

Background: Total Knee Replacement (TKR) is a very successful operation but like all surgery carries risks. Complications can arise immediately or shortly after surgery. Patients can be readmitted back to hospital for a number of reasons, but not all necessarily linked to post-operative complications.  We wanted to quantify the risk of readmission within 30 days of surgery and analyse the reasons.

Aim: To identify causes of readmission after TKR & their frequency , within 30 days of surgery.

Methodology: Data spanning 2 years (Apr 2018- Apr 2020) were analysed. Patients’ details were retrieved for those with at least one readmission within 30 days of TKR
The following data was retrieved:

• Time to readmission
• Reason, duration and outcome of readmission
• Specialty of readmission
• Patient demographics (including ASA grade)

Results: Over the 2 year period analysed, 1259 patients underwent TKR; 81 of these (6.4%) were readmitted within 30 days.

• 40 % of readmitted patients stayed for less than a day while 3% stayed for 17 days.  90% were admitted for less than 10days.
• 41% were admitted under the medical team, 27% under A&E, 26% under orthopaedics, 5% under urology, and 1% under care of the elderly.
• Only 15 % of readmissions could be directly linked to TKR.
• The main reasons for readmission were (Please order from big to small): pulmonary emboli (2 patients), DVT (1 patient), wound cellulitis (2), chest infection ,urinary retention,urinary tract infection, and 2 haematuria

Conclusion: Most readmissions occurred within the first ten days post-operative, yet most could not be directly linked to the surgery in question.However it is likely that surgery was a contributing factor. 

• There were a broad range of reasons for readmission including chest, urinary, and wound infection. 
• Though 28 admissions were for suspected DVT/PE, only 3 thrombolic events were confirmed.
• Further research should be aimed at identifying effective ways of reducing post-operative complications, including investigating the role of routine chest physiotherapy, urinary catheterization, and regular wound surveillance.

Biography:

Amr Mohamed Foad Mohamed is a Trauma & Orthopaedics Registrar at Watford General Hospital with a strong academic and clinical background. He completed Core Surgical Training with a focus on T&O in the East Midlands Deanery and has demonstrated proficiency in managing acute trauma cases and performing complex procedures, including neck of femur and ankle fracture surgeries. He holds a PGCert in Medical Education from Cardiff University and is actively involved in undergraduate and postgraduate teaching with Imperial College London and the University of Leicester. Dr Basha is the first author of a systematic review on buprenorphine for postoperative pain and a co-author in multiple orthopaedic publications. His audit and quality improvement projects have been presented nationally and internationally. He has a long-term interest in hip and knee arthroplasty, robotic surgery, and medical education, aiming to contribute to global orthopaedic outreach work in the future.