Factors that influence the mortality of patients following hip hemiarthroplasty.

INTRODUCTION: Hip hemiarthroplasty (HHA) is one of the most common types of orthopedic surgery. With the prevalence and utilization of the surgery increasing year after year, this procedure is found to be associated with severe postoperative complications and eventually mortality. Thus, it is crucial to understand the factors that increase the risk of mortality following HHA. METHODS: Using the Nationwide Inpatient Sample (NIS) database, patients undergoing HHA from 2016 to 2019 were identified. This sample was stratified into a mortality group and a control group. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS: Of the 84,067 patients who underwent the HHA procedures, 1,327 (1.6%) patients died. Additionally, the mortality group had a higher percentage of patients who were non-electively admitted (P < 0.001) and diabetic patients with complications (P < 0.001), but lower incidences of tobacco-related disorders (P < 0.001). Significant differences were also seen in age (P < 0.001), length of stay (P < 0.001), and total charges (P < 0.001) between the two groups. Preoperatively, those aged > 70 years (OR: 2.11, 95% CI [1.74, 2.56], P < 0.001) had diabetes without complications (OR: 0.32, 95% CI [0.23, 0.44], P < 0.001), tobacco-related disorders (OR: 0.24, 95% CI [0.17, 0.34], P < 0.001) and increased rates of mortality after HHA. Postoperatively, conditions, such as pulmonary embolisms (OR: 6.62, 95% CI [5.07, 8.65], P < 0.001), acute renal failure (OR: 4.58 95% CI [4.09, 5.13], P < 0.001), pneumonia (95% CI [2.72, 3.83], P < 0.001), and myocardial infarctions (OR: 2.65, 95% CI [1.80, 3.92], P < 0.001) increased likelihood of death after undergoing HHA. Patients who were electively admitted (OR: 0.46 95% CI [0.35, 0.61], P < 0.001) had preoperative obesity (OR: 0.67, 95% CI [0.44, 0.84], P = 0.002), and a periprosthetic dislocation (OR: 0.51, 95% CI [0.31, 0.83], P = 0.007) and were found to have a decreased risk of mortality following THA. CONCLUSIONS: Analysis of pre- and postoperative complications relating to HHA revealed that several comorbidities and postoperative complications increased the odds of mortality. Old age, pulmonary embolisms, acute renal failure, pneumonia, and myocardial infraction enhanced the odds of post-HHA mortality.

What are the predisposing factors for periprosthetic fractures following total hip arthroplasty? - a National Inpatient Sample-based study.

INTRODUCTION: With a progressive rise in the number of total hip arthroplasties (THA) over the past decades, the proportion of patients sustaining peri-prosthetic fractures (PPF) has been substantially increasing. In this context, the need for clearly understanding the factors predisposing patients to PPF following THA and the impact of these adverse complications on the overall healthcare burden cannot be understated. MATERIALS AND METHODS: Based upon the Nationwide Inpatient Sample (NIS) database, the patients who underwent THA in the United States between 2016 and2019 (with ICD-10 CMP code) were identified. The patients were divided into 2 groups; group A - patients who sustained PPF and group B - those who did not. The information about the patients' demographic profile, medical comorbidities; and hospital admission (including length of stay and expenditure incurred) were analysed; and compared between the 2 groups. RESULTS: Overall, 367,890 patients underwent THA, among whom 4,425 (1.2%) sustained PPF (group A). The remaining patients were classified under group B (363,465 patients). On the basis of multi-variate analysis (MVA), there was a significantly greater proportion of females, elderly patients, and emergent admissions (p < 0.001) in group A. The length of hospital stay, expenditure incurred and mortality were also significantly higher (p = 0.001) in group A. Based on MVA, Down's syndrome (odd's ratio 3.15, p = 0.01), H/O colostomy (odd's ratio 2.09, p = 0.008), liver cirrhosis (odd's ratio 2.01, p < 0.001), Parkinson's disease (odd's ratio 1.49, p = 0.004), morbid obesity (odd's ratio 1.44, p < 0.001), super obesity (odd's ratio 1.49, p = 0.03), and H/O CABG (coronary artery bypass graft; odd's ratio 1.21, p = 0.03) demonstrated significant association with PPF (group A). CONCLUSION: Patients with PPF require higher rates of emergent admission, longer hospital stay and greater admission-related expenditure. Female sex, advanced age, morbid or super obesity, and presence of medical comorbidities (such as Down's syndrome, cirrhosis, Parkinson's disease, previous colostomy, and previous CABG) significantly enhance the risk of PPF after THA. These medical conditions must be kept in clinicians' minds and close follow-up needs to be implemented in such situations so as to mitigate these complications.

Cardiac interventions on total knee arthroplasty: a national inpatient sample-based analysis.

BACKGROUND: Comorbid cardiovascular diseases have been associated with poor outcomes in total knee arthroplasty (TKA); however, our understanding of TKA with prior cardiac treatment procedures has largely been undocumented. In this study, we examined TKA patients who had undergone different cardiac interventions that addressed their condition. The purpose was to characterize and compare outcomes for a growing patient population not yet analyzed. MATERIALS AND METHODS: The 2016-2019 Nationwide Inpatient Sample database was queried for 558,256 patients who had TKA (ICD-10CM). Backgrounds significant for pacemaker [PM] (n = 8025), coronary artery bypass [CABG] (n = 12,683), heart valve surgery [HV] (n = 4125), or coronary stent [CS] (n = 19,483) were compared against those without, across demographics, admission information, and various complications. RESULTS: Cardiac interventions were associated with increased age, male gender, length of stay, and cost of care. CABG, and Stent groups had more diabetics, but HV had significantly fewer (p = 0.008). PM and HV had significantly less tobacco use and, in addition to CABG, less obesity. Postoperatively, mortality was elevated in the PM [Odds ratio (OR) 2.89, p = 0.008], CABG (OR 2.53, p = 0.006) and CS group (OR 1.94, p = 0.018), but not HV. Myocardial infarctions were elevated in the CABG (OR 3.874) and CS group (OR 5.11) (p < 0.001). PM, HV, and CS had increased odds of periprosthetic fracture by 2.15-fold (p < 0.001), 2.09-fold (p < 0.001), 1.29-fold (p = 0.011) respectively. HV saw increased periprosthetic mechanical complications (OR 1.48, p = 0.006). CABG increased the odds of deep surgical site infection 14.23-fold and CS 9.22-fold (p < 0.001). Postoperative pneumonia was increased in PM, CABG, and CS groups (OR 2.15,), (OR 2.21,), (OR 1.64,) (p < 0.001). CONCLUSIONS: Patients who have undergone cardiac intervention are generally at risk for adverse stays. Furthermore, risk factors and complications vary between the groups. Our analysis emphasizes the importance of individualized medical care and as a basis for electing and informing patients for TKA.

Patient disposition after discharge following primary total hip arthroplasty: home versus skilled nursing facility-a study based on national inpatient sample database.

INTRODUCTION: In view of the shortened length of hospital stay following THA, an increasing proportion of patients have required transfer to "extended-care" (ECF) or "skilled nursing" facilities (SNF) over the past years. As a result, the expenditure related to postoperative care facility has been acknowledged as a crucial component of total economic burden associated with THA. In this context, the clinical and demographic factors leading to the need for transfer of patients to SNF following primary THA need to be clearly understood. METHODS: The NIS database was utilised to identify the patients, who underwent primary THA between 2016 and 2019. The patients were then grouped under two categories: group A-patients who required post-THA transfer to SNF; and group B-those who were discharged home. The details regarding patients' demographic profile, medical comorbidities and complication profile during the perioperative period were recorded; and compared between groups A and B. RESULTS: Based on the database, 368,431 patients underwent primary THA between 2016 and 2019; among whom, 67,498 (18.3%) were transferred to SNF (group A) following the surgery. Among the various comorbidities evaluated [on multivariate analysis (MVA)], uncomplicated DM (OR 1.45; p < 0.001), CKD (OR 1.47; p < 0.001), cirrhosis (OR 1.83; p < 0.001), Parkinson's disease (OR 3.94; p < 0.001), previous H/O dialysis (OR 2.84; p < 0.001), colostomy (OR 2.03; p < 0.001) or organ transplant (OR 1.42; p < 0.001); morbid obesity (OR 1.72; p < 0.001), cocaine abuse (OR 1.76; p < 0.001); and legal blindness (OR 2.58; p < 0.001) were associated with significantly greater need for post-THA transfer to SNF. Among the systemic complications reviewed (on MVA), pneumonia (odds ratio 3.2; p < 0.001), DVT (odds ratio 2.58; p < 0.001), higher need for blood transfusions (odds ratio 2.55; p < 0.001), ARF (odds ratio 2.32; p < 0.001), MI (odds ratio 2.2; p < 0.001), anaemia (odds ratio 1.65; p = 0.002) and PE (odds ratio 1.56; p < 0.001) significantly raised the probability of need for higher discharge destinations. In addition, prosthesis-related local complications such as prosthetic dislocation (OR 1.59; p < 0.001), fracture (OR 2.64; p < 0.001) or early peri-prosthetic infection (PPI; OR 1.71; p = 0.01) also necessitated specialised facilities of care following THA. CONCLUSION: We could observe that 0.2% of patients required transfer to SNF following primary THA. Comorbidities such as Parkinson's disease, previous H/O dialysis, legal blindness and H/O colostomy had the highest odds of necessitating patient disposition to SNF. The occurrence of one or more systemic complications including pneumonia, DVT, ARF, MI, PE, and blood loss anaemia (or need for blood transfusion) or local prosthesis-related complications (dislocation, fracture or infections) substantially increased the chances of requiring transfer to a specialised care facility.

Understanding factors that impact the length of stay after total hip arthroplasty - A national in-patient sample-based study.

Background: Total hip arthroplasty (THA) is increasingly used every year; however, there is currently limited information on factors that impact the length of stay (LOS) following the procedure. Longer LOS following THA is met with an increase in the cost of care, necessitating studies to identify factors that may impact LOS. Methods: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 to analyze the preoperative comorbidities and postoperative complications that impact the LOS following THA. We divided our cohort into patients with a LOS greater than two days, and patients with a LOS less than two days. Results: A total of 367,890 patients were identified in the NIS database who underwent THA during the study period. Of this cohort, 112,288 (30.52%) patients were identified as having a LOS greater than two days, while the remaining 255,602 (69.48%) patients were patients who had a LOS less than two days. Multivariate analysis demonstrated several pre-operative factors, such as diabetes, systemic lupus erythematosus, organ transplant, dialysis, the human immunodeficiency virus, chronic kidney disease, and Parkinson's disease, were independently associated with a higher risk of a LOS greater than two days. The subsequent multivariate analysis for post-operative variables demonstrated that acute renal failure, myocardial infarction, blood loss anemia, blood transfusion, pulmonary embolism, deep vein thrombosis, periprosthetic fracture, periprosthetic mechanical complications, periprosthetic infections, and wound dehiscence were all independently associated with a higher risk of a LOS greater than two days. Conclusions: Several pre-operative comorbidities and postoperative complications were found to increase the likelihood of a LOS greater than two days. In addition, the group with a LOS greater than two days incurred a higher cost of care. This information is useful for providers to make informed decisions regarding patient care and resource utilization for patients undergoing THA, potentially reducing LOS.

Factors that increase the rate of periprosthetic dislocation after reverse shoulder arthroplasty.

INTRODUCTION: Reverse shoulder arthroplasty (RSA) is considered one of the greatest technological innovations in shoulder reconstruction surgery, as evidenced by the fact its growth rate of usage is greatest among all shoulder arthroplasties. However, like all arthroplasties, a post-surgical complication often arises. One of these complications, periprosthetic dislocation (PPD), requires revision and poses, therefore, a burden on both patients and healthcare providers. While PPD is understood to be a complication of RSA, it is unclear to what extent certain risk factors and co-morbidities predispose patients to post-RSA PPD. The purpose of this study was to identify and evaluate the impact of specific risk factors and co-morbidities that contribute to the development of PPD following RSA. METHODS: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016-2019 to analyze the prevalence and impact of various risk factors and co-morbidities on the incidence of PPD following RSA. A univariate and subsequent multivariate logistic regression model was made to provide a descriptive association between variables that impact the rates of PPD after RSA. RESULTS: The NIS database identified 59,925 patients, 1,000 of whom experienced a PPD while the remaining 58,825 were placed in the non-PPD group (controls). The PPD group consisted predominantly of females (53.10%) and Caucasians (86.30%). There was a higher incidence of tobacco-related disorders (P = 0.003), obesity (P < 0.001), morbid obesity (P < 0.001), liver cirrhosis (P < 0.001), and Parkinson's disease (PD) (P < 0.001) in PPD patients compared to controls. Young patients had a 1.89-fold increased odds (OR: 1.89, 95% CI [1.58, 2.26], P < 0.001), patients with tobacco-related disorders had decreased odds (OR: 0.80, 95% CI [0.67, 0.97], P = 0.02), morbidly obese patients had 1.50 times the odds (OR: 1.50, 95% CI [1.14, 1.97]), liver cirrhosis patients had 2.67-fold increased odds (OR: 2.67, 95% CI [1.55, 4.60], P < 0.001), and Parkinson's disease patients had 2.66 times the odds (OR: 2.66, 95% CI [1.78, 3.96], P < 0.001) to develop PPD following RSA compared to patients who did not have the corresponding condition. CONCLUSIONS: Patients with specific risk factors and co-morbidities are predisposed to developing PPD after RSA. Risk factors that were found to be associated with a higher incidence of PPD are gender (female), race (Caucasian), and age (young patients). Analysis revealed the history of tobacco-related disorder, obesity, morbid obesity, liver cirrhosis, and Parkinson's disease increased the odds of developing PPD following RSA. These findings can inform both healthcare providers and patients to improve RSA surgical outcomes and tailor post-surgery recovery programs to fit the patient's needs.

Uncemented Hemiarthroplasty in Displaced Femoral Neck Fractures is associated with Higher Perioperative Surgical Complications but Lower Medical Complications: Analysis from the National Inpatient Database.

Objectives: This study aimed to analyze and compare the perioperative outcomes of cemented and uncemented hemiarthroplasty in elderly patients with displaced femoral neck fractures by utilizing the data from the National Inpatient Sample database. Methods: Data from the National Inpatient Sample Database was analyzed to identify patients who underwent hemiarthroplasty following a displaced femoral neck fracture (cemented and uncemented. Demographic data, comorbidities, length of stay, total charges, and perioperative complications were analyzed. Results: 27390 patients were identified in the cemented group and 29406 in the uncemented group. The patients who underwent uncemented hemiarthroplasty demonstrated a higher incidence of prosthetic dislocation (Odds Ratio (OR) 3.348, p < 0.001), periprosthetic mechanical complications (OR 2.597, p < 0.001), wound dehiscence (OR 2.883, p < 0.001), superficial surgical site infection (OR 2.396, p = 0.043), deep surgical site infection (OR 1.686, p < 0.001), and periprosthetic fractures (OR 2.292, p < 0.001) as compared with patients who underwent cemented hemiarthroplasty. However, patients with uncemented fixation demonstrated a lower incidence of death (OR 0.567, p < 0.001), pulmonary embolism (OR 0.565, p < 0.001), deep vein thrombosis (DVT) (OR 0.746, p < 0.001), myocardial infarction (OR 0.772, p = 0.025) and blood loss anemia (OR 0.869, p < 0.001) as compared with cemented fixation. Conclusion: Our study on displaced femoral neck fractures utilizing the National Inpatient database found that uncemented hemiarthroplasty was associated with a higher incidence of perioperative surgical complications. Cemented hemiarthroplasty, however, was associated with a statistically significant higher rate of death, pulmonary embolism, deep vein thrombosis, and myocardial infarction.

Hospital characteristics and perioperative complications of Hispanic patients following reverse shoulder arthroplasty-a large database study.

BACKGROUND: Hispanic patients are the youngest and fastest-growing ethnic group in the USA. Many of these patients are increasingly met with orthopedic issues, often electing to undergo corrective procedures such as reverse shoulder arthroplasty (RSA). This patient population has unique medical needs and has been reported to have higher incidences of perioperative complications following major procedures. Unfortunately, there is a lack of information on the hospitalization data and perioperative complications in Hispanic patients following procedures such as RSA. This project aimed to query the Nationwide Inpatient Sample (NIS) database to assess patient hospitalization information, demographics, and the prevalence of perioperative complications among Hispanic patients who received RSA. METHODS: Information from 2016-2019 was queried from the NIS database. Demographic information, incidences of perioperative complications, length of stay, and costs of care among Hispanic patients undergoing RSA were compared to non-Hispanic patients undergoing RSA. A subsequent propensity matching was conducted to consider preoperative comorbidities. RESULTS: The query of NIS identified 59,916 patients who underwent RSA. Of this sample, 2,656 patients (4.4%) were identified to be Hispanic, while the remaining 57,260 patients (95.6%) were found to belong to other races (control). After propensity matching, Hispanic patients had a significantly longer LOS (median = 1.4 days) than the patients in the control group (median = 1.0, P < 0.001). The Hispanic patients (89,168.5 USD) had a significantly higher cost of care than those in the control group (67,396.1 USD, P < 0.001). In looking at postoperative complications, Hispanic patients had increased incidences of acute renal failure (Hispanics: 3.1%, control group: 1.1%, P = 0.03) and blood loss anemia (Hispanics: 12.7%, control group: 10.9%, P = 0.03). CONCLUSIONS: Hispanic patients had significantly longer lengths of stay, higher costs of care, and higher rates of perioperative complications compared to the control group. For patients who are Hispanic and undergoing RSA, this information will aid doctors in making comprehensive decisions regarding patient care and resource allocation.

Total knee arthroplasty in dialysis patients: a national in-patient sample-based study of perioperative complications.

BACKGROUND: Chronic kidney disease (CKD) is a growing disease that affects millions of people in the USA every year. Many CKD patients progress to end-stage renal disease (ESRD), necessitating the use of hemodialysis to alleviate symptoms and manage kidney function. Furthermore, many of these patients have lower bone quality and experience more postoperative complications. However, there is currently limited information on hospitalization information and perioperative complications in this population following procedures such as total knee arthroplasty (TKA). The purpose of this study was to assess the patient characteristics, demographics, and prevalence of postoperative problems among dialysis patients who received TKA. METHODS: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) data from 2016 to 2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing TKA who were categorized as dialysis patients, compared with those who were not. Propensity matching was conducted to consider associated factors that may influence perioperative complications. RESULTS: From 2016 to 2019, 558,371 patients underwent TKAs, according to the National In-Sample (NIS) database. Of those, 418 patients (0.1%) were in the dialysis group, while the remaining 557,953 patients were included in the control group. The mean age of the dialysis group was 65.4 ± 9.8 years, and the mean age in the control group was 66.7 ± 9.5 years (p = 0.006). After propensity matching, dialysis group patients had a higher risk of receiving blood transfusions [odds ratio (OR): 2; 95% confidence interval (CI): 1.2, 3.4] and a significantly larger COC in comparison to those in the control group (91,434.3 USD versus 71,943.6 USD, p < 0.001). In addition, dialysis patients had significantly higher discharges to another facility, as compared with the control group patients. CONCLUSIONS: The dialysis group had a significantly higher cost of care, higher rates of requiring blood transfusion, and more cases of being discharged to another facility than non-dialysis patients. This data will help providers make informed decisions about patient care and resource allocation for dialysis patients undergoing TKA.

The effect of cocaine on patients undergoing total hip arthroplasty.

Background: Cocaine use has surged in the past decade, with 4.8 million Americans (1.7% of the population greater than 12) reporting use in 2021, leading to a healthcare burden of 1.3 billion dollars. Cocaine users experience prolonged hospital stays, higher costs, worse surgical outcomes, increased risk of medical conditions, and inflammation-related osteoarthritis. The study aims to identify factors influencing length of stay, costs, and perioperative complications in cocaine users undergoing total hip arthroplasty (THA) to reduce these risks. Methods: This study utilized the NIS database, providing comprehensive information on patient demographics, length of stay, hospital costs, and complications. Statistical analyses were conducted using SPSS software, including propensity matching and significance testing, to compare outcomes between cocaine users (CU) and non-cocaine users (NCU) undergoing total hip arthroplasty. Results: After propensity matching, cocaine users had a significantly longer LOS (4.8 days) in comparison to non-cocaine users (2.6 days) (p < 0.001). Similarly, the CU group had a larger of care (87984.9) than the NCU group (69149.2) (p < 0.001). Cocaine users had significantly higher rates of blood loss anemia (OR: 3.24, 95% CI: 2.21, 4.73), blood loss anemia (OR: 1.59, 95% CI: 1.12, 2.24), blood transfusion (OR: 2.23, 95% CI: 1.04, 4.78), periprosthetic dislocation (OR: 6.57, 95% CI: 1.47, 29.32), and periprosthetic infection (OR: 4.59, 95% CI: 1.54, 13.68) than patients in the non-cocaine user's group. Conclusion: Cocaine users had a significantly longer length of stay, higher costs of care, and an increased number of post-operative complications compared to non-cocaine users. These data contribute to understanding the potential ramifications of cocaine users undergoing THA.

Reverse Shoulder Arthroplasty in Nonagenarians - NIS-based study of perioperative and postoperative complications.

Purpose: Our aim is to investigate the length of stay (LOS), cost of care (COC) and postoperative complications associated with reverse shoulder arthroplasty (RSA) in nonagenarians (people aged 90-99 years old). Methods: We used the National Inpatient Sample (NIS) database to identify 59,925 patients who underwent RSA between 2016 and 2019, including 555 nonagenarians. We investigated the incidences of various medical and orthopedic postoperative complications in nonagenarians compared to their younger counterparts, as well as compared nonagenarians undergoing elective and non-elective surgery. Results: Nonagenarians were less likely admitted for elective surgery (69.9% in nonagenarians vs 92.8% in controls, p < 0.001) and were subject to longer LOS (3.5 days in nonagenarians vs 1.89 days in controls, p < 0.001) and greater COC ($91,794.69 US in nonagenarians vs $79,574.12 US in controls, p < 0.001). Nonagenarians had increased incidences of hospital mortality (0.72% in nonagenarians vs 0.06% in controls, p < 0.001), pneumonia (1.44% in nonagenarians vs 0.37% in controls, p < 0.001), blood loss anemia (22.34% in nonagenarians vs 10.12% in controls, p < 0.001), and ARF (6.85% in nonagenarians vs 2.18% in controls, p < 0.001). Nonagenarians undergoing elective RSA had fewer complications than those requiring non-elective RSA. Conclusion: Nonagenarians undergoing RSA are subject to increased LOS, COC, and postoperative complications. Despite this, we feel that the associated complications can be deemed acceptable and that with adequate preparation, the benefits of a successful RSA may outweigh the associated complications in elderly patients. This is important to aid clinicians and patients in making informed decisions for patient care and resource allocation, as well as highlights room for improvement in costs and hospital stay, as well as sheds light on persistent health disparities in orthopedic surgery. Level of evidence: IV.

Patient Characteristics, Length of Stay, Cost of Care, and Complications in Super-Obese Patients Undergoing Total Hip Arthroplasty: A National Database Study.

Background: The purpose of this study was to compare postoperative complication rates in super-obese (SO) patients with a body mass index (BMI) ≥ 50 kg/m2 undergoing total hip arthroplasty (THA) versus non-super-obese (NSO) patients undergoing THA. Methods: In this retrospective study using the National Inpatient Sample (NIS) database, 1,646 cases of THA in SO (BMI ≥ 50 kg/m2) patients were reviewed. We used International Classification of Diseases (ICD)-10 codes to assess postoperative variables including length of stay, cost of care (cost of inpatient hospitalization), and medical and surgical complications among SO patients undergoing THA compared to NSO patients before being discharged. Results: A comparison of demographic variables showed there were more women in both groups and nearly 17.2% of SO patients were diabetic patients, 11.1% of SO patients were tobacco users, and 74.8% of the SO patients were whites (African American, 15.1%; Hispanic, 2.9%). The mean length of stay was 3.43 days in the SO group and 2.32 days in the NSO group, and this difference was statistically significant. The cost of care was $79,784.64 for the SO group, which was significantly higher than $66,821.75 for the NSO group. The SO group also showed higher odds of developing medical complications such as anemia (odds ratio [OR], 1.555; 95% confidence interval [CI], 1.395-1.734; p < 0.001), acute renal failure (OR, 3.375; 95% CI, 2.816-4.045; p < 0.001), pneumonia (OR, 2.319; 95% CI, 1.241-4.331; p = 0.014), and need for blood transfusion (OR, 1.596; 95% CI, 1.289-1.975; p < 0.001). The SO patients also showed a higher risk of several postoperative surgical complications such as periprosthetic fractures, infection, and wound dehiscence. Conclusions: Postoperative complication rates in SO patients were higher than those in the NSO group. Length of stay and cost of care were higher, whereas the mean age was lower for the SO group. Therefore, THA in SO patients should be undertaken only after careful consideration and preferably in a tertiary facility capable of handling all medical and surgical in-hospital complications.

Ankylosing spondylitis substantially increases health-care costs and length of hospital stay following total hip arthroplasty - National in-patient database study.

Introduction: The outcome following major arthroplasty surgeries in patients with ankylosing spondylitis (AS) has tremendously improved over the past decades, due to substantial amelioration in the medical therapies and sophistication of available surgical modalities. Although various studies have already demonstrated the complication rates and challenges faced in AS patients undergoing THA, there is a substantial paucity of data on the actual healthcare burden associated with this disease, and the diverse factors which may affect it. Methods: Using the National Inpatient Sample (NIS) database (on the basis of ICD-10 CMP codes), patients undergoing THA between the years 2016 and 2019 were identified. These patients were then classified into two categories: group A: patients with a known diagnosis of AS; and group N: those without. The details regarding demographical information, associated co-morbidities, data pertaining to patients' hospital admissions including expenditure incurred, length of stay and complications encountered, were compared. In addition, propensity-score matching was performed to identify a 1:1 matched sample of THA patients without AS. Results: Overall, 367,890 patients underwent THA; among whom, 501 (0.14%) were known AS patients (group A). Group A included a substantially higher proportion of patients belonging to younger age group (58.6 ± 13.4 versus 65.9 ± 11.4 years; p < 0.001), male sex (67.1% in group A vs 44.1% in group N; p < 0.001), and Asian ethnicity (p < 0.001). Group A patients had a substantially higher risk for longer duration of hospital stay (p < 0.03) and higher overall healthcare expenditure incurred (p < 0.001). As compared to group N, AS patients had a significantly higher risk for developing post-operative anemia [21.8% (group A) vs 11.8% (group N); p < 0.02]; and higher rate of periprosthetic infections [2.4% (group A) vs 1.0% (group N); p < 0.007]. Conclusion: Patients with AS require a significantly longer duration of hospital stay and higher admission-related expenditure following THA, as compared to the general population. These enhanced early health care-associated costs can be attributed to higher complication rates in AS patients. AS patients are prone to higher rates of anemia and peri-prosthetic infections during the early post-THA period.

Total Hip Arthroplasty in Nonagenarians - A National In-Patient Sample-Based Study of Perioperative Complications.

Background: Nonagenarians are a rapidly expanding population in the United States. These patients are met with increasing rates of hip arthritis, necessitating the need for total hip arthroplasty (THA). However, there is currently limited information on hospitalization information and perioperative complications in this population. Methods: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016-2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THAs who were categorized as nonagenarians, and those who were not. Results: The NIS database identified 309 100 patients who underwent THAs from 2016-2019. Of those, 1864 patients (.6%) were nonagenarian, while the remaining 307 236 patients were included under the non-nonagenarian category (control). The mean age in the nonagenarian group was 90 years compared to the control group which had a mean age of 65.8 years. There was an increased incidence of mortality rate (nonagenarian group .2%, control group .03%, P < .001), myocardial infarction (MI) (nonagenarian group .1%, control group .02%, P = .01), acute renal failure (ARF) (nonagenarian group 5.4%, control group 1.6%, P < .001), blood anemia post-operatively (nonagenarian group 28.9%, control group 17.2%, P < .001), and deep vein thrombosis (DVT) (nonagenarian group .48%, control group .07%, P < .001) in the nonagenarian group. The COC for the nonagenarian group was higher than that in the control group (P < .001). The mean LOS was longer in the nonagenarian group (3.1 days) in comparison to the control group (1.96 days) (P < .001). Conclusions: Nonagenarians had significantly higher rates of both orthopedics and medical complications than the younger patients undergoing THAs. In addition, the nonagenarian group incurred higher COC. This information is useful for the providers to make informed decisions regarding patient care and resource utilization for nonagenarian patients undergoing THAs.

Analysis of inpatient complications in HIV/AIDS patients undergoing total hip arthroplasty - A propensity matched cohort study.

Patients with human immunodeficiency virus (HIV) are at higher risk for orthopedic related diseases due to dysregulation in bone metabolism and metabolic effects related to their medication regimen. Furthermore, the rate of hip arthroplasty in HIV patients is increasing. With the recent changes in THA methodologies and improvements in HIV treatment, there is a need for updated research analyzing hip arthroplasty outcomes in this high-risk patient population. In this study, we used a national database to evaluate postoperative outcomes in HIV patients undergoing THA compared to THA patients without HIV. We use a propensity algorithm to create a cohort of 493 HIV negative patients for matched analysis. Among the 367,894 THA patients included in this study, 367,390 patients were HIV negative and 504 were HIV positive. The HIV cohort had a lower mean age (53.34 vs 65.88, p < 0.001), lower proportion of females (44% vs 76.4%, p < 0.001), lower incidence of diabetes without complications (5% vs 11.1%, p < 0.001) and a lower incidence of obesity (0.544 vs 0.875, p = 0.002). In the unmatched analysis, the incidence of acute kidney injury (4.8% vs 2.5%, p = 0.004), pneumonia (1.2% vs 0.2%, p = 0.002), periprosthetic infection (3.6% vs 1%, p < 0.001), and wound dehiscence (0.6% vs 0.1%, p = 0.009) were higher in HIV cohort, most likely due to inherent demographic variances present in the HIV population. In the matched analysis, the rates of blood transfusion (5.0% vs 8.3%, p = 0.041) were lower in the HIV cohort. Other post-operative variables, such as rates of pneumonia, wound dehiscence, and surgical site infections were not statistically significant between the HIV positive population and HIV negative matched cohort. Our study found similar rates of postoperative complications in HIV positive and HIV negative patients. The rate of blood transfusions in HIV positive patients was also noted to be lower. Our data suggests that THA is a safe procedure in patients infected with HIV.

Perioperative complications of legally blind patients undergoing total hip arthroplasty - A national in-patient sample database study.

Background: Legally blind patients are more prone to injury-related falls, which may lead to hip fractures, often necessitating total hip arthroplasty (THA), as a corrective procedure. Many of these patients have unique medical needs and have increased rates of perioperative complications following surgical procedures. However, there is limited information on the hospitalization data and perioperative complications in this population following guidelines such as THA. The purpose of this study was to evaluate the patient characteristics, demographics, and prevalence of perioperative issues among THA patients who were legally blind. Methods: Using 2016-2019 data from the Nationwide Inpatient Sample (NIS), the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THA who were categorized as legally blind patients, compared to those who were not were analyzed. Propensity matching was conducted to consider associated factors that may influence perioperative complications. Results: From 2016 to 2019, 367,856 patients underwent THA, according to the NIS. Of those, 322 (0.1%) patients were categorized as legally blind, and the remaining 367,534 (99.9%) patients were not identified as legally blind (control). Legally blind patients were significantly younger than the control group (65.4 years vs. 66.7 years, p < 0.001). After propensity matching, legally blind patients had longer LOS (3.9 days vs. 2.8, p = 0.04), increased discharges to another facility (45.9% vs. 29.3%, p < 0.001), and fewer discharges to home (21.4% vs. 32.2%, p = 0.02) than control patients. Conclusions: The legally blind group had significantly longer LOS, higher rates of discharge to another facility, and lower rates of discharge to home compared to the control group. This data will help providers make informed decisions about patient care and resource allocation for legally blind patients undergoing THA.

Total Knee Arthroplasty in Patients with Spinal Cord Injury: Impact on Medical Complications, Hospital Costs and Length of Stay.

INTRODUCTION: Patients with spinal cord injury (SCI) with degenerative joint disease of the knee may require total knee arthroplasty (TKA). This study examines the demographic and immediate postoperative outcomes of patients with SCI who undergo TKA. METHODS: Admissions data for TKA and SCI were analyzed from the National Inpatient Sample database using International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes. An extensive array of preoperative and postoperative variables was compared among SCI TKA patients and non-SCI TKA patients. An unmatched and matched analysis using a 1:1 propensity match algorithm was conducted to compare the two groups. RESULTS: Patients with SCI tend to be younger and have a 7.518 times greater risk of acute renal failure, 2.3 times greater risk of blood loss, and higher risk of local complications, including periprosthetic fracture and prosthetic infection. The average length of stay in the SCI cohort was 2.12 times greater, with a 1.58 times higher mean total incurred charge than the non-SCI group. CONCLUSION: SCI is associated with an increased risk of acute renal failure, blood loss anemia, periprosthetic fractures and infections, a longer length of stay, and greater incurred charges in TKA patients. STUDY DESIGN: Retrospective study.

Postoperative complications of spinal vs general anesthesia in elderly patients undergoing hip hemiarthroplasty.

INTRODUCTION: Elderly patients with hip fractures are at high risk for mortality due to postsurgical complications. Hip hemiarthroplasty is a routine procedure done in elderly patients for surgical repair  of femoral neck fractures. Both general and spinal anesthesia can be used in elderly patients undergoing hemiarthroplasty. Rates of postoperative complications among the two anesthetic choices have not been directly compared. In this study, we compare the rates of postoperative complications in elderly patients (age greater than 70) undergoing hip hemiarthroplasty for femoral neck fractures using a national database. METHODS: Data for the years 2015-2020 from the National Surgical Quality Improvement Program (NSQIP) were used for the study. Patients greater than 70 years of age who received a hip hemiarthroplasty with general anesthesia or spinal anesthesia were identified using CPT procedure codes. Pertinent preoperative variables and rates of postoperative complications were characterized and analyzed. RESULTS: Our study found that elderly patients who received spinal anesthesia had, on average, longer length of stays but shorter operative times compared to patients who received general anesthesia. Furthermore, we found that patients who received spinal anesthesia had lower rates of systemic sepsis, cardiac arrests, and blood transfusions when compared to patients who received general anesthesia. Finally, we found that overall rates of mortality were significantly lower in the spinal anesthesia cohort compared to the general anesthesia cohort. CONCLUSION: Our work suggests that patients who underwent spinal anesthesia for hip arthroplasty may have lower rates of postoperative complications. This work further highlights the role of anesthetic choice in preventing complications following hip hemiarthroplasty procedures.

What enhances the in-hospital mortality following total hip arthroplasty? A national inpatient sample-based study.

PURPOSE: With prolonged life expectancy and advancements in prosthetic designs, the proportion of patients belonging to diverse age groups undergoing total hip arthroplasty (THA) has progressively increased. In this context, the details regarding risk factors associated with mortality after THA, and its prevalence need to be clearly understood. This study sought to identify the possible co-morbidities associated with post-THA mortality. METHODS: Based on Nationwide Inpatient Sample (NIS) database, patients undergoing THA from 2016 to 2019 (using ICD-10CMP) were identified. The included cohort was stratified into two groups: "early mortality" and "no mortality" groups. The data regarding patients' demographics, co-morbidities, and associated complications were compared between the groups. RESULTS: Overall, 337,249 patients underwent THA, among whom, 332 (0.1%) died during their hospital admission ("early mortality" group). The remaining patients were included under "no mortality" group (336,917 patients). There was significantly higher mortality in the patients, who underwent emergent THA (as compared with elective THA: odd's ratio 0.075; p < 0.001). Based on multivariate analysis, presence of liver cirrhosis, chronic kidney disease (CKD) and previous history of organ transplant increased the odds of mortality {odds ratio [Exp (B)]} after THA by 4.66- (p < 0.001), 2.37-fold (p < 0.001) and 1.91-fold (p = 0.04), respectively. Among post-THA complications, acute renal failure (ARF), pulmonary embolism (PE), pneumonia, myocardial infarction (MI), and prosthetic dislocation increased the odds of post-THA mortality by 20.64-fold (p < 0.001), 19.35-fold (p < 0.001), 8.21-fold (p < 0.001), 2.71-fold (p = 0.05) and 2.54-fold (p < 0.001), respectively. CONCLUSION: THA is a safe surgery with low mortality rate during early post-operative period. Cirrhosis, CKD, and previous history of organ transplant were the most common co-morbidities associated with post-THA mortality. Among post-operative complications, ARF, PE, pneumonia, MI, and prosthetic dislocation substantially enhanced the odds of post-THA mortality.

Dialysis Patients Undergoing Total Hip Arthroplasty have Higher Rates of Morbidity and Mortality and Incur Greater Healthcare Costs: A National Database Study from 367,894 Patients.

Purpose: The incidence of a total hip arthroplasty (THA) is sevenfold higher in dialysed patients. Only a few have specifically studied the impact of chronic dialysis on outcomes of THA whilst comparing them with non-dialysed/controls. The present study questioned whether significant differences existed in morbidity and mortality rates after THA in dialysed and non-dialysed patients. Methods: The National Inpatient Sample (NIS) database Healthcare Cost and Utilization Project using records for THAs performed during 2016-2019 was employed. This largest, nationwide, in-patient database in the US acquires data from > 7 million hospital stays annually from > 20% hospitals. Among 367,894 THAs performed during 2016-2019, 383 were regularly dialysed. The two groups (dialysis and controls) were compared for in-hospital mortality, demographic data, perioperative details and medical/surgical complications. Results: Dialysed patients were younger (p < 0.001), had greater mortality (0.5% vs 0.09%, p = 0.005), lengths of stay (4.4 vs 2.3 days, p < 0.001), costs ($96,824 vs $66,848, p < 0.001) and male preponderance (p < 0.001). Postoperative dislocations (3.1% vs 1.4%, p = 0.013), mechanical complications (p = 0.032) and blood loss (p = 0.031) were greater in dialysed patients. Medical postoperative complications (myocardial infarction, pneumonia, thromboembolism, acute renal failure), periprosthetic fractures, wound dehiscence, superficial and deep surgical-site infection and periprosthetic joint infections were comparable between the 2 groups. Dialysed patients had elective THAs more often (25% vs 8.6%). Controls had higher (twofold) home discharges while ~ 50% of dialysed THAs needed discharge to another facility. Conclusions: This large national data highlighted greater morbidity and mortality among dialysis patients following THA, something to consider preoperatively along with individual circumstances whilst making risk-benefit assessments for arthroplasty. Improvements in healthcare could bridge gaps between outcomes and expectations in dialysed patients.