Bending the odds: Clinical predictors of 30-day morbidity and surgical outcomes following total knee arthroplasty.

Abstract

Total knee arthroplasty (TKA) is a widely performed, cost-effective treatment for advanced knee osteoarthritis. Over 600,000 procedures are performed annually in the United States, projected to reach 3.5 million by 2030. Despite high implant survivorship (>90 % at 10-15 years post-operation), complications such as mortality, readmission, and reoperation remain predominant. Enhanced recovery after surgery (ERAS) protocols and diverse alignment techniques have improved outcomes. However, to address patient dissatisfaction and improve perioperative care, this study aimed to identify independent predictors of 30-day mortality, readmission, and reoperation. Data were extracted from the American College of Surgeons' NSQIP database (2018-2022). Adult patients undergoing elective primary TKA (n = 307,952) were included. Logistic regression models were performed to assess associations between clinical variables and each post-surgical outcome. Among 307,952 cases, there were 274 deaths, 8550 readmissions, and 3051 reoperations.Top predictors of <b>mortality</b> included chronic renal failure (OR 16.4), ASA Class IV (OR 5.3), functional dependence (OR 3.25), ASA III (OR 2.6), and PRBC transfusion (OR 1.35).Top predictors of <b>readmission</b> included functional dependence (OR 1.95), CHF (OR 1.82), COPD (OR 1.74), ASA IV (OR 1.68), and ASA III (OR 1.54).Top predictors of <b>reoperation</b> included chronic renal failure (OR 2.42), ASA IV (OR 1.78), CHF (OR 1.63), COPD (OR 1.49), and ASA III (OR 1.39). Systemic disease burden, functional status, and ASA class consistently predicted adverse outcomes. These findings support the integration of individualized risk stratification into preoperative planning and ERAS protocols to improve TKA outcomes.