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Departments: CE Tests

Bilateral Total Knee Arthroplasty

Predictors of Discharge Disposition

doi: 10.1097/NOR.0000000000000646
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Disclosure: The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

This article has been approved by the Orthopaedic Nurses Certification Board for Category A credit toward recertification as an ONC.

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GENERAL PURPOSE: To present the details of a retrospective database study conducted to determine personal and comorbid characteristics of patients undergoing simultaneous bilateral total knee arthroplasty predictive of length of stay and discharge to a skilled nursing facility.

LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:

  1. Summarize the findings from the review of the literature useful for understanding the purpose and goals of the authors' study.
  2. Evaluate the results of the authors' study and any implications for practice.
  1. The authors noted that one of the primary reasons for the vast increase in the total number of total knee arthroplasties (TKAs) being performed over the past 15 years is an increase in the prevalence of
    1. osteoporosis.
    2. rheumatoid arthritis.
    3. knee injuries among younger patients.
  2. A study by Memtsoudis and colleagues found that, compared with the unilateral TKA (UTKA) group, patients undergoing simultaneous bilateral TKA (BTKA) had
    1. more comorbidities.
    2. a 1.6 times higher rate of mortality.
    3. a 2.5 times higher rate of procedure-related complications.
  3. The 2013 Consensus Conference on Bilateral Total Knee Arthroplasty and a study by Bohm and colleagues affirmed a higher prevalence of which of the following comorbidities among these patients?
    1. obesity
    2. hypertension
    3. diabetes mellitus
  4. Meehan and colleagues and others reported that patients undergoing which of the following procedures had the highest prevalence of obesity?
    1. UTKA
    2. staged BTKA
    3. simultaneous BTKA
  5. A study by Ayyar and colleagues comparing obese and non-obese patients undergoing UTKA found that, postoperatively, patients with a higher body mass index (BMI) had
    1. higher pain scores.
    2. more complications.
    3. more functional difficulty.
  6. Bohm and colleagues and others reported that increased length of stay (LOS) after TKA has been associated with
    1. male sex.
    2. living in a deprived area.
    3. having a high-volume surgeon.
  7. According to Bohm and colleagues, compared with men undergoing TKA, women
    1. had a longer LOS.
    2. received more blood transfusions.
    3. had higher pulmonary emboli rates.
  8. Danninger and colleagues reported that a decreased hospital LOS has been associated with
    1. home health aide care.
    2. same-day physical therapy.
    3. improved perioperative pain control.
  9. Two U.S. studies and one Canadian study noted that, compared with UTKA, the proportion of patients undergoing simultaneous BTKA who were transferred to transitional care was
    1. larger.
    2. smaller.
    3. about the same.
  10. The results of the authors' study indicated that the most common comorbidity among the patients whose records they examined was
    1. dementia.
    2. heart disease.
    3. diabetes mellitus.
  11. On a 0 to 10 scale, the mean pain score for the patients whose records the authors examined postoperatively was
    1. 4.4.
    2. 5.2.
    3. 6.1.
  12. The one patient the authors eliminated due to a lengthy hospital stay had cardiopulmonary disease, dementia, and
    1. chronic obstructive pulmonary disease.
    2. hypercholesteremia.
    3. diabetes mellitus.
  13. One of the only two significant predictors of increased LOS indicated by the multiple linear regression model was
    1. BMI.
    2. marital status.
    3. time in the operating room.
  14. Three variables predicted skilled nursing facility (SNF) disposition in the binary logistic regression model: age, sex, and
    1. dementia.
    2. cardiopulmonary disease.
    3. total number of comorbidities.
  15. While not significant, compared with men, how much more likely were women to be discharged to an SNF?
    1. much more likely
    2. about as likely
    3. much less likely
  16. Patients who had cardiopulmonary disease were how many times more likely to go to an SNF?
    1. 4
    2. 8
    3. 12
  17. The mean LOS for patients undergoing simultaneous BTKA in the authors' study was
    1. 4.01 days.
    2. 5.1 days.
    3. 5.8 days.
  18. The authors suggested that patients who went to an SNF
    1. had cardiopulmonary disease.
    2. lacked caregiver support at home.
    3. already had a lengthy hospital stay.
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