# Intensive care needs after hip and knee replacement: understanding risk profiles for severe postoperative complications

## TL;DR

This study identifies risk factors for severe postoperative complications requiring intensive care after hip and knee replacement surgeries.

## Contribution

The study identifies independent predictors of ICU transfers after joint arthroplasty, offering insights for risk assessment and prehabilitation.

## Key findings

- Frailty, cardiological and gastrointestinal diagnoses, and anticoagulant use are independent risk factors for ICU transfers.
- Patients requiring ICU care after surgery are older, more frail, and have more comorbidities.
- A multidisciplinary approach including prehabilitation is recommended to reduce ICU events.

## Abstract

The etiology of serious life-threatening events after total joint arthroplasty (TJA) is poorly elaborated and understood in literature. The purpose of this study was to identify independent predictors of postoperative intensive care following total hip arthroplasty (THA) and total knee arthroplasty (TKA) and to clarify the circumstances leading to these transfers.

A total of 142 patients suffering from postoperative intensive care-dependent serious adverse events (Clavien–Dindo classification Grade IV, CD°IV) after THA or TKA were matched 1:1 with non-CD°IV patients using propensity score matching for age, sex, comorbidity (Charlson Comorbidity Index, CCI), and year of treatment. Possible predictive factors for the need of postoperative intensive care were initially evaluated using univariate tests, followed by multivariate regression analyses to identify independent predictors.

CD°IV transfers correlate with higher Hospitality Frailty Risk Score levels (HFRS) [mean 4.4 (standard deviation, SD 3.8) versus mean 3.0 (SD 3.0); p < 0.001], higher American Society of Anesthesiologists Physical Status Classification System (ASA) Scores [mean 2.5 (SD 0.6) versus mean 2.3 (SD 0.7); p = 0.02], a greater proportion of octogenarians [35.9% (n = 51) versus 23.9% (n = 34); p = 0.028] and a higher incidence of medical complications [97.9% (n = 139) versus 60.6% (n = 86); p < 0.001] compared with an adjusted control group after total joint arthroplasty (TJA).

Multivariate regression analysis confirmed “Frailty” (odds ratio, OR 1.14, 95% confidence intervals, CI 1.05–1.23, p = .002), preexisting cardiological (odds ratio, OR 2.0, 95% confidence intervals, CI 1.004–4.1, p = 0.049) and gastrointestinal secondary diagnoses (OR 3.0, 95% CI 1.3–6.9, p = 0.01), and intake of anticoagulants (OR 2.7, 95% CI 1.6–4.6, p < 0.001) as independent risk factors for CD°IV intensive care unit (ICU) transfers after TJA.

Patients with CD°IV events after THA and TKA represent a complex, vulnerable, and multimorbid patient population. There is a need for a multidisciplinary approach that integrates prehabilitation and perioperative risk assessments to reduce the occurrence of severe, life-threatening events requiring ICU care.

Level III—retrospective cohort study.

Retrospectively registered.

The online version contains supplementary material available at 10.1186/s10195-025-00862-x.