| OBJECTIVE: To determine if any differences existed in the early complication rate, short-term clinical outcome, overall hospital costs and total length of hospital stay between patients who had BTHA or BTKA performed under a single anesthetic (during 1 patient visit to the operating room) and patients who had the procedure performed under 2 anesthetics (during 2 patient visits to the operating room). METHODS: Patients operated on BTHA were divided into 2 groups: Group A (1 stage procedure)-ips that were operated on simultaneously (134 hips) and Group B (2 stage procedure)-ourgeries performed between 2 months and 11 months apart (62 hips). All patients were evaluated after an average follow-up of 47.6 months. Similarly, patients operated on bilateral total knee arthroplasty were also divided into 2 groups: Group C (1 stage procedure)knees that were operated on simultaneously (76 knees) and Group D (2 stage procedure)~surgeries performed between 3 months and 10 months apart (58 knees). All patients were evaluated after an average follow-up of 24.3 months. RESULTS: Between the 2 groups operated on BTHA, there were no differences in operative, short-term clinical outcome and postoperative length of hospital stay. But there were higher incidence of early local, or general complications in Group A. Hematoma and cardiopulmonary complications were approximately 2.1 and 2.4 times greater in Group A. No higher incidence of pulmonary embolism or deep vein thrombosis was found in the 1 stage group. Preoperatively, very stiff hips (total range of motion < 50 degrees) gained significantly more motion in the 1 stage group than in the 2 stage groups. The mean score of Harris after surgery was similarity in statistics between 2 groups, but patients in the 1 stage group had a significantly better capacity for walking after their procedure. Average totalhospital stay was 17 to 18 days less for the patients in Group A than those in Group B, which, combined with using the operating room only once, resulted in a reduction of overall hospital costs by 30.2% when using the 1 stage procedure.Between the 2 groups operated on BTKA, there were no differences in short term clinical outcome and postoperative length of hospital stay. But postoperative cardiovascular complications were significantly greater in Group C than those in Group D, and were associated significantly with preoperative cardiovascular complication. Cardiopulmonary and deep vein thrombosis complications were approximately 3.9 and 2.3 times greater in Group C. postoperative fever and confusion complications were approximately 2.3 and 3.5times greater in Group C. The mean score of HSS after surgery were similarity between the 2 groups. Average total hospital stay was 21 to 22 days less for the patients in Group C than those in Group D, which, combined with using the operating room only once, resulted in a reduction of overall hospital costs by about 32.3% when using the 1 stage procedure. CONCLUSION: There were no differences hi short term clinical outcome and postoperative length of hospital stay, between patients who had BTHA or BTKA performed under a single anesthetic (during 1 patient visit to the operating room) and patients who had the procedure performed under 2 anesthetics (during 2 patient visits to the operating room). The intraoperative complication rate was similarity between patients who had BTHA or BTKA performed in one stage procedure and patients who had performed in 2-stage procedure, but there was an increased risk of cardiovascular complications during the postoperative period in BTHA or BTKA in one stage procedure. Patients with a preexisting cardiovascular condition compared with those in one stage procedure were greater in 2-stage procedure. BTHA and BTKA in one stage procedure reduced overall hospital costs, but there were higher risk than those in2-stage procedure. Therefore, using BTHA or BTKA in one stage procedure must be cautious in elder patients, patients with a preexisting cardiovascular condition and the hospital where tec...
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