NINETY DAYS MORBIDITY AND MORTALITY IN PATIENTS UNDERGOING PRIMARY ELECTIVE TOTAL KNEE ARTHROPLASTY IN A MULTISPECIALITY HIGH VOLUME CENTER.

Presenting Author - DHIRAJ K MAROTHI
Intro: TKA has proved its effectiveness and safety in improving quality of life in arthritic patients. Various factors preoperatively determine ninety days mortality and morbidity. 90 Days mortality is reported in the literature is 0.4% . M &M: Prospectively, 2000 patients from Nov 2014 to Aug 2015 undergoing primary elective TKA are included in study. Pre-op ASA grade and DC-comorbidity score were given to each patient as a measure of surgical risk and functional outcome. Functional outcomes were measured by Oxford score and KSS. Both local and systemic complications like infection, DVT, Pulmonary Embolism, Acute Renal Failure, Pulmonary and cardiac complications and mortality with its cause were assessed within 90 days. Results: Av age of patient in our study is 68.7 years. 1327(66.3%) were female and 673(33.7%) were male. Bil. Most common diagnosis was osteoarthritis (98%). Av BMI was 28.9 kg/m2. Patients with normal BMI (<24.9), overweight (<29.9), obese(<39.9) and morbidly obese(>39.9) were 497(24.9%), 679(34%), 717(38.5%) and 78(3.9%) respectively. Mean DC score was 3.27. Patients in ASA grade Ia, Ib, IIa, IIb and III were 325(16.2%), 202(10.1%), 569(28.5%), 536(26.8%) and 368(18.4%) respectively. Av pre-op and 90 day oxford score were 50.9 and 24.9. Knee score were 31.9 and 56.5 respectively.Vascular complication occured in two patients (0.1%) in whom significant delay in recovery and less than average functional recovery was expected. Our rates of sup and deep infection and PE were 0.8%, 0.3% and 0.1%. Two male patients(0.1%) (one bilateral and one unilateral), having ASA grade IIb and III died within 3 months period, one from multi-organ failure and the other from PE. In 28 patients in whom post-op complications were occured, 18 patients (64%%) were in ASA Grade III. Average Charlson score was 4.64. Average BMI is 32.9 with 13 patients (46.4%) had BMI more than 35. Females were 15 (53.5%) and 15 patients (53.5%) were of age more than 70 bilateral. All two patients who died were male. Conclusion: Predictors for ninety days mortality and morbidity are multivariable, including older age, male sex, higher BMI, higher D-C index, prior cardiac disease and higher ASA grade. In our study older age, male gender, ASA grade IIb and III, higher D-C index bilateral are associated with higher ninety day morbidity and mortality. Operating these patients in multispeciality center, following fixed institutional protocol, can optimize disease management which can reduce post operative morbidity and mortality following TKA.