Primary Hip & Knee Arthroplasty
Canceled Total Joint Arthroplasty: Who, What, When, and Why?

https://doi.org/10.1016/j.arth.2020.09.006Get rights and content

Abstract

Background

Unexpected cancelation of scheduled total joint arthroplasty (TJA) procedures creates patient distress and disruption for the clinical team. The purpose of this study is to identify the etiology and fate of cancelations for scheduled TJAs.

Methods

A consecutive series of 11,670 patients at a single institution from 2013 to 2017 was reviewed in March 2020. All patients who were scheduled for a primary total hip arthroplasty or total knee arthroplasty and subsequently canceled were identified. The etiology of cancelation and time to rescheduling were recorded.

Results

Of the 505 (4.3%) canceled patients, 209 (42%) were due to medical reasons. Three hundred ninety-one patients (77%) eventually underwent their procedure at a mean delay of 165 days (19-1908). Only 53 (25%) patients canceled for a medical reason underwent further diagnostic or therapeutic intervention for their medical condition. When compared to patient-driven cancelations, those canceled for medical reasons had a higher mean Charlson Comorbidity Index (0.82 vs 0.39, P < .001), were canceled closer to the scheduled surgery date (8.55 vs 18.1 days, P < .001), and were more likely to eventually undergo surgery (86% vs 73%, P = .004).

Conclusion

Canceled elective TJA surgeries are most often due to a medical concern, however only a minority of these patients undergo intervention for that medical condition. To minimize the risk of cancelation, healthcare providers may consider early referral of medically complex patients to the patient’s primary care physician. After cancelation, patients should have a clearly defined path to return to the operative schedule to prevent further delays.

Section snippets

Methods

This study was approved by, and conducted in accordance with, our Institutional Review Board and no outside funding was received for this study. A consecutive series of 11,670 primary THA and TKA patients at a single institution from January 2013 through March 2017 was reviewed in March and April of 2020. All patients were scheduled to have their TKA or THA completed by one of the 6 surgeons who specialize in TKA and THA procedures. The flowchart can be seen in Figure 1.

All patients who were

Results

Of the 11,670 patients who were scheduled for a primary TKA or THA during the study period, 505 (4.3%) had their surgery canceled at least once. As Table 1 shows, there was a slightly higher percentage of females who had their surgery canceled than males (53% vs 47%, P = .041). Patients who had their TKA canceled had a significantly higher body mass index than those who had their THA canceled (31.1 vs 29.0, P < .001). The mean Charlson Comorbidity Index of all patients was 0.64 (standard

Discussion

Elective procedure cancelations occurring before TJA are an inevitable part of every surgeon’s practice. Patients suffering from end-stage degenerative joint disease have an obvious desire to undergo the procedure but any number of scenarios may result in cancelation. Previous data from orthopedic specialties have found the cancelation rate for elective surgeries to be between 10% and 35% of cases [4,19]. Our analysis of a single academic institution found that about 1 out of every 23 patients

References (40)

  • J.L.H. Phillips et al.

    How much does a readmission cost the bundle following primary hip and knee arthroplasty?

    J Arthroplasty

    (2019)
  • A.H.S. Harris et al.

    Can machine learning methods produce accurate and easy-to-use prediction models of 30-day complications and mortality after knee or hip arthroplasty?

    Clin Orthop Relat Res

    (2019)
  • E.M.M. Turunen et al.

    Financial cost of elective day of surgery cancellations

    J Hosp Adm

    (2018)
  • C.P. Childers et al.

    Understanding costs of care in the operating room

    JAMA Surg

    (2018)
  • J.M. Ehrenfeld et al.

    Case cancellation rates measured by surgical service differ whether based on the number of cases or the number of minutes cancelled

    Anesth Analg

    (2013)
  • F.J. Hafkamp et al.

    Do dissatisfied patients have unrealistic expectations? A systematic review and best-evidence synthesis in knee and hip arthroplasty patients

    EFORT Open Rev

    (2020)
  • M.G. de Tejada et al.

    A prospective study of the association of patient expectations with changes in health-related quality of life outcomes, following total joint replacement

    BMC Musculoskelet Disord

    (2014)
  • R. Tay Swee Cheng et al.

    Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review

    Disabil Rehabil

    (2015)
  • F. Desmeules et al.

    Waiting for total knee replacement surgery: factors associated with pain, stiffness, function and quality of life

    BMC Musculoskelet Disord

    (2009)
  • I.N. Ackerman et al.

    Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

    BMC Musculoskelet Disord

    (2011)
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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2020.09.006.

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