Prevalence and Risk Factors of Intensive Care Unit Admission Following Joint Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND

Total joint arthroplasty (TJA) is a frequent and safe procedure; however, some patients experience complications requiring intensive care unit (ICU) admission, which increases morbidity, longer hospital stays, and healthcare costs. This study aimed to estimate the pooled prevalence of ICU admission following TJA and identify associated risk factors to aid perioperative risk stratification.

METHODS

PubMed, Embase, Scopus, and Web of Science were systematically searched for studies reporting ICU admission rates and risk factors after TJA. Two reviewers independently performed study selection, data extraction, and quality assessment. A meta-analysis of proportions was used to estimate the pooled prevalence of ICU admissions. Subgroup analyses were performed by surgical site, procedure type, region, and study design. Pooled odds ratios (ORs) for 17 predefined risk factors were calculated using random-effects models. Heterogeneity was assessed using I2 statistics, and publication bias was evaluated with the Egger test.

RESULTS

Ninety-six studies were included, and the pooled prevalence of ICU admission was 5.68% (95% confidence interval [CI] 4.24-7.62%, I2 = 99.98%). The strongest predictors of ICU admission were intraoperative vasopressor use (OR 5.03, 95% CI 2.78-9.1), coronary artery disease (CAD) (OR 4.31, 95% CI 2.18-8.55), chronic kidney disease (CKD) (OR 3.09, 95% CI 1.56-6.13), anemia (OR 3.20, 95% CI 1.45-7.06), and revision hip arthroplasty (OR 3.59, 95% CI 2.36-5.46). Age older than 75 (OR 2.81, 95% CI 1.5-5.26) and body mass index >35 (OR 2.42, 95% CI 1.38-4.24) were also associated with increased risk.

CONCLUSION

ICU admission occurs in approximately 5.6% of TJA cases. Major predictors include vasopressor use, revision hip surgery, anemia, CAD, and CKD. These findings provide a foundation for evidence-based perioperative risk assessment and optimized resource allocation.

PROSPERO REGISTRATION CODE: CRD42024558273.

LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.