key: cord-1019164-zzl0c9nj
authors: Sukhonthamarn, Kamolsak; Grosso, Matthew J.; Parvizi, Javad
title: Response to Letter to the Editor titled ‘Risk Modeling for Unplanned Intensive Care Unit (ICU) Admission’
date: 2020-05-08
journal: J Arthroplasty
DOI: 10.1016/j.arth.2020.05.005
sha: 944cba2f5e96645c23e4d49b431c9981f470eec6
doc_id: 1019164
cord_uid: zzl0c9nj

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To the Editor in reply,

We are grateful to the letter authors for their interest in our study regarding risk factors for unplanned intensive care unit (ICU) admission after elective total joint arthroplasty, which was recently published in the Journal of Arthroplasty [1] .

We agreed with the authors that in this arduous situation of the COVID-19 pandemic nationwide and around the world, issues related to medical resource utilization have become paramount for healthcare providers. Therefore, the American College of Surgeons (ACS) and the Centers for Medicare and Medicaid Services (CMS) have recommended postponing or canceling elective procedures, including total joint arthroplasty (TJA) [2, 3] . The questions from the letter writers are timely and appropriate regarding triage of urgent-procedures related to total joint arthroplasty, including periprosthetic joint infection, periprosthetic fracture, and prosthetic dislocation. Our ultimate goal is to have an arthroplasty procedure based calculator that can cover these urgent procedures, similar to the current ACS NSQIP risk calculator [4] .

As we hopefully return to normalization during this critical period and re-start elective cases, we hope our findings in the published study can help surgeons reduce the risk of ICU admission. We report significantly increased risks with bilateral versus unilateral hip There is previously published work on predictors and risk-stratified model development, which was created from stratified preoperative and intraoperative factors to predict unplanned ICU admission after total hip arthroplasty (THA) [5] [6] [7] . We think this model is interesting and important for clinical use. Therefore, as suggested by the letter writers, we are developing a risk calculator tool from our database and extending it to evaluate multiple preoperative factors that influence and weight the risk for ICU admission.

We want to thank the authors for their invaluable comments and suggestions. We hope that our future work can further help plan appropriately for healthcare resource management, especially in this time of crisis for both surgeons and patients.

Risk Factors for Unplanned Admission to the Intensive Care Unit After Elective Total Joint Arthroplasty

COVID-19: Recommendations for Management of Elective Surgical Procedures

American College of Surgeons

Unplanned Admission to the Intensive Care Unit After Total Hip Arthroplasty

Prospective Study of Unplanned Admission to the Intensive Care Unit after Total Hip Arthroplasty

Which patients need critical care intervention after total joint arthroplasty?: a prospective study of factors associated with the need for intensive care following surgery