[Analysis on the causes of unscheduled suspensions of knee and hip arthroplasty].

OBJECTIVE: To analyze and summarize the causes of unscheduled suspension of knee and hip arthroplasty and to provide the method for optimizing the patient's preoperative management and improving the efficiency of medical resources as well as the patient's satisfaction.

METHODS: The data for this report was retrospectively collected from September 2013 to August 2014 in our hospital, from cases of knee and hip arthroplasty that were suspended before the scheduled operation time. Acquisition data from the collected cases including the patients' gender, age and the surgical procedure. At the same time, the suspension reasons were recorded and analyzed. All the decisions of suspension was made by the surgeons and the anesthesiologists according to the abnormal result of preoperative examinations, after communicating with the patients and their families and obtaining their understandings.

RESULTS: In the collecting period, our department scheduled 1 146 cases of knee and hip arthroplasty, among which 1 003 were completed, 143 suspended (12.5% suspension rate). Among the causes of suspension, the top four common causes were cardiovascular disease (44/143, 31%), other infections (20/143, 14%), bacteriuria (18/143, 13%) and inappropriate surgical indication (16/143, 11%). Other causes include surgeon's reason, Blood system abnormalities, high inflammatory index, deep vein thrombosis, other diseases uncontrolled, abnormal liver function and poor diabetes mellitus control, etc. For the rate of suspension, there was no significant difference between the patients with different genders (male: 15.0%, and female: 11.7%, P=0.149), or age (≤50 years: 13.0%; 51-65 years: 11.6%; 66-80 years 13.3%; >80 years 11.1%; P=0.864). However compared with knee arthroplasty, hip arthroplasty had a higher suspension rate (knee arthroplasry 11.1%, hip arthroplasry 16.1%, P=0.021).

CONCLUSION: It is important to educate and manage the patients before their knee and hip arthroplasty. Through clear diagnosis, detailed medical history analysis careful physical examination, and targeted outpatient examinations and tests for which priority was focused on cardiovascular or other system diseases we could minimize the occurrence of operative suspension post hospitalization, therefore improving the efficiency of the use of medical resources.