The Impact of Chronic Obstructive Pulmonary Disease on Postoperative Outcomes in Patients Undergoing Revision Total Knee Arthroplasty

Background: Total knee arthroplasty (TKA) utilization is increasing in older Americans. The incidence of chronic obstructive pulmonary disease (COPD) has been steadily rising over the past few decades. In particular, COPD is being increasingly more common in patients undergoing revision TKA. The aim of this study is to identify the impact of COPD on postoperative complications for patients undergoing revision TKA. Methods: A retrospective cohort study was conducted using data collected through the American College of Surgeons National Quality Improvement Program Database. All patients who underwent revision TKA between 2007 and 2014 were identified and stratified into groups based on COPD status. The incidence of adverse events after surgery was evaluated with univariate and multivariate analyses where appropriate. Results: Patients with COPD were found to develop more postoperative complications, including deep wound infection, organ infection, wound dehiscence, pneumonia, reintubation, renal insufficiency, urinary tract infection, myocardial infarction, sepsis, and death. Patients with COPD were also shown to have to return back to the operating room and have an extended length of hospital stay. COPD was shown to be an independent risk factor for development of wound dehiscence, pneumonia, reintubation, renal insufficiency, and renal failure. Finally, COPD was identified as an independent risk factor for unplanned return to the operating room. Conclusion: Patients with COPD have greater risk for postoperatively developing wound dehiscence, pneumonia, reintubation, renal insufficiency, and renal failure complications than those without COPD. While risks for independent complications remain relatively low, consideration of COPD status is an important factor to consider when selecting surgical candidates and preoperative risk assessment.