Association between preoperative cerebrovascular accidents with length of hospital stay among patients undergoing primary unilateral total knee arthroplasty in Singapore: a single-center retrospective study

Abstract

Background Multiple studies have suggested that preoperative cerebrovascular accidents (CVA) are linked to unfavorable outcomes in elective orthopedic surgeries. The objective of this study was to evaluate whether a prior history of CVA has an independent association with the length of hospital stay (LOS) in patients who undergo primary unilateral total knee arthroplasty (TKA). Methods For this retrospective cohort study, a total of 2083 patients who underwent unilateral TKA at a tertiary academic medical center in Singapore between January 2013 and June 2014 were included. Univariate and multivariate linear regression analyses were utilized to identify the independent risk factors associated with LOS. Furthermore, subgroup and interaction analyses were conducted to assess the relationship between CVA and LOS. Results A total of 2083 eligible patients, comprising 1576 females and 507 males, were enrolled in the study. Among them, 2039 had a history of CVA, while the remaining 44 did not. The ethnic distribution was as follows: 83.7% (n = 1743) Chinese, 7.3% (n = 152) Indian, 6.0% (n = 125) Malay, and 3.0% (n = 63) from other ethnicities. The mean age of the sample was 66.5 years, with a median LOS of 4.0 days. The risk factors identified for prolonged LOS were as follows: age equal to or older than 65 years, regional anesthesia, perioperative blood transfusion of 1 unit, perioperative blood transfusion of more than 2 units, American Society of Anesthesiologist Physical Status (ASA) class III, diabetes mellitus, ischemic heart disease, CVA, creatinine level greater than 2 mg/dL, preoperative hemoglobin level between 11-12.9 g/dL, preoperative hemoglobin level greater than or equal to 13 g/dL, and TKA performed on Thursday. Furthermore, a significant association between CVA and LOS was observed using multivariable logistic regression analyses after adjusting for potential confounders. The adjusted odds ratio for prolonged LOS in patients with CVA compared to those without CVA was 3.24. Conclusion Patients with a previous history of CVA undergoing unilateral TKA are at a heightened risk of enduring a significantly prolonged LOS compared to those without a history of CVA. To enhance patient care and establish suitable perioperative guidelines, close collaboration among orthopedic, medical, and neurological teams is crucial.