Factors That Predict Short-term Complication Rates After Total Hip Arthroplasty
There remains uncertainty regarding the relative importance of patient factors such as comorbidity and provider factors such as hospital volume in predicting complication rates after total hip arthroplasty (THA).
We therefore identified patient and provider factors predicting complications after THA.
We reviewed discharge data from 138,399 patients undergoing primary THA in California from 1995 to 2005. The rate of complications during the first 90 days postoperatively (mortality, infection, dislocation, revision, perioperative fracture, neurologic injury, and thromboembolic disease) was regressed against a variety of independent variables, including patient factors (age, gender, race/ethnicity, income, Charlson comorbidity score) and provider variables (hospital volume, teaching status, rural location).
Compared with patients treated at high-volume hospitals (above the 20th percentile), patients treated at low-volume hospitals (below the 60th percentile) had a higher aggregate risk of having short-term complications (odds ratio, 2.00). A variety of patient factors also had associations with an increased risk of complications: increased Charlson comorbidity score, diabetes, rheumatoid arthritis, advanced age, male gender, and black race. Hispanic and Asian patients had lower risks of complications.
Patient and provider characteristics affected the risk of a short-term complication after THA. These results may be useful for educating patients and anticipating perioperative risks of THA in different patient populations.
Level of Evidence
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
- Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619. CrossRef
- Hip and Knee Arthroplasty: Annual Report 2009. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2009.pdf. Accessed March 23, 2010.
- Karrholm J, Garellick G, Rogmark C, Herberts P. Swedish Hip Arthroplasty Register: Annual Report 2007. Available at: http://www.jru.orthop.gu.se/. Accessed March 23, 2010.
- Katz JN, Losina E, Barrett J, Phillips CB, Mahomed NN, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2001;83:1622–1629. CrossRef
- Katz JN, Phillips CB, Baron JA, Fossel AH, Mahomed NN, Barrett J, Lingard EA, Harris WH, Poss R, Lew RA, Guadagnoli E, Wright EA, Losina E. Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery. Arthritis Rheum. 2003;48:560–568. CrossRef
- Mahomed NN, Barrett JA, Katz JN, Phillips CB, Losina E, Lew RA, Guadagnoli E, Harris WH, Poss R, Baron JA. Rates and outcomes of primary and revision total hip replacement in the United States Medicare population. J Bone Joint Surg Am. 2003;85:27–32.
- National Center for Health Statistics. CDC Web site. National Hospital Discharge Survey: 2002 Public Use Data File Documentation.Available at: http://www.cdc.gov/nchs/injury/injury_hospital.htm. Accessed March 23, 2010.
- Puolakka TJ, Pajamaki KJ, Halonen PJ, Pulkkinen PO, Paavolainen P, Nevalainen JK. The Finnish Arthroplasty Register: report of the hip register. Acta Orthop Scand. 2001;72:433–441. CrossRef
- Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care. 2002;40:675–685. CrossRef
- Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res. 2007;457:35–41. CrossRef
- SooHoo NF, Lieberman JR, Ko CY, Zingmond DS. Factors predicting complication rates following total knee replacement. J Bone Joint Surg Am. 2006;88:480–485. CrossRef
- Soohoo NF, Zingmond DS, Lieberman JR, Ko CY. Primary total knee arthroplasty in California 1991 to 2001: does hospital volume affect outcomes? J Arthroplasty. 2006;21:199–205. CrossRef
- Zingmond DS, Ye Z, Ettner SL, Liu H. Linking hospital discharge and death records–accuracy and sources of bias. J Clin Epidemiol. 2004;57:21–29. CrossRef
- Factors That Predict Short-term Complication Rates After Total Hip Arthroplasty
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Clinical Orthopaedics and Related Research®
Volume 468, Issue 9 , pp 2363-2371
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Orthopaedic Surgery, UCLA School of Medicine, 10945 Le Conte Avenue, PVUB #3355, Los Angeles, CA, 90095, USA
- 2. Department of Orthopaedic Surgery, University of Connecticut, Farmington, CT, USA
- 3. Department of General Internal Medicine and Health Services Research, UCLA School of Medicine, Los Angeles, CA, 90095, USA