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Hypoxemia following total joint arthroplasty may predict medical complications, researchers suggest
Thursday, November 06 2008 | Comments
What's This?
Researchers studied a consecutive series of patients who underwent total joint arthroplasty between Jan. 1 and Nov. 15, 2006. A total of 2,216 arthroplasties were performed in 1,971 patients. Overall, 1,158 surgeries were hip arthroplasties (1,091 patients) and 1,058 surgeries were knee arthroplasties (880 patients). Pulse oximetry with routine vital signs were recored every 6 hours following the operation.
The data revealed that 78 patients (4.0%) experienced an acute episode of hypoxemia during their postoperative recovery in the hospital, and hypoxemia occurred more often during the second day after the surgery (mean, 2 days). Thirteen of the 78 patients (17%) had hypoxemia during the evening of the joint arthroplasty.
The investigators detected and confirmed 6 different etiologies for hypoxemia: pulmonary embolism (15%), pulmonary edema (13%), pneumonia (4%), chronic obstructive pulmonary disease (4%), atelectasis (33%), or narcotics (3%). Although 27% of the hypoxemia cases could not be traced to a known cause, the authors hypothesized that central or obstructive apnea were the most likely causes.
After adjusting for all variables in a multivariate regression analysis, only tachypnea was a significant predictor of pulmonary embolism (P=.008). Body mass index was a predictor for pulmonary edema (P=.01), and diabetes mellitus was a predictor for atelectasis
(P=.02).
"In conclusion, we found pulse oximetry a useful tool in the perioperative care of the arthroplasty patient. Hypoxemia could be found in 4% of the patients," the authors noted.
They also added that, "Hypoxemia alone or in correlation with other clinical variables was not found to be specific for a particular etiology and further diagnostic evaluation should be considered." (Austin L, et al. J Arthro 2008:23:1016-1021.)
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