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Does systemic lupus erythematosus impact the peri-operative complication rates following primary total knee arthroplasty? A national inpatient sample-based large-scale study

  • Knee Arthroplasty
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Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Consequent to improved life expectancies, there has been a substantial increase in the proportion of patients with systemic lupus erythematosus (SLE) undergoing total knee arthroplasty (TKA) over the past 2 decades. In comparison to the other inflammatory disorders, the complication rates and post-operative outcome in patients with SLE are less clearly understood, owing to the paucity of evidence in the literature.

Methods

Patients who underwent TKA between 2016 and 2019 were identified (ICD-10CMP code) using the National Inpatient Sample (NIS) database and then classified into one of the two groups, namely those with SLE (ICD-10-CM; code710.0) and those without SLE (NSLE). Demographic details, co-morbidities, details regarding hospital stay, costs incurred, and complications encountered of this patient cohort were analysed and compared between the two groups.

Results

Overall, among 5,58,361 patients undergoing TKA, 2,094 (0.38%) patients had SLE. The SLE group was significantly younger than NSLE population (62.2 ± 9.9 vs 66.7 ± 9.5 years; p < 0.001). The proportion of female and African-American patients was higher in the SLE group (p < 0.001). SLE patients had a significantly longer hospital stay (p < 0.001) and greater hospital-related expenditure (p < 0.001). Among the peri-operative complications, SLE patients had significantly greater risk of developing post-operative anemia (19.2% in SLE vs 15.3% in NSLE; p < 0.001), requiring blood transfusion (2.8% in SLE vs 1.5% in NSLE; p < 0.001), and acquiring peri-prosthetic joint infections (1.9% in SLE vs 1% in NSLE; p < 0.001).

Conclusion

The presence of SLE significantly lengthens hospital stay, and augments the health-care-related costs in patients undergoing TKA. The rates of peri-prosthetic infections, post-operative anemia, and need for blood transfusions are significantly greater in SLE patients.

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Acknowledgements

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The authors declare that no funds, grants, or other supports were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of MSK Oncology, University of Calgary, Calgary, AB, Canada

    Vibhu Krishnan Viswanathan

  2. School of Medicine, University of Texas Medical Branch, Texas, USA

    Vishaal Sakthivelnathan

  3. Carroll High School, Dallas, TX, USA

    Tejas Senthil

  4. Salem VA Medical Center, Salem, VA, USA

    Anil Menedal

  5. Boston University, Staff orthopedic surgeon, Boston VAMC, Boston, MA, USA

    Prabhudev Prasad Purudappa

  6. Department of Orthopedics, Chief of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA

    Varatharaj Mounasamy

  7. University of Texas Southwestern, Staff Orthopedic Surgeon, Dallas VAMC, Dallas, TX, USA

    Senthil Sambandam

Authors
  1. Vibhu Krishnan Viswanathan
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  2. Vishaal Sakthivelnathan
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  3. Tejas Senthil
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  4. Anil Menedal
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  5. Prabhudev Prasad Purudappa
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  7. Senthil Sambandam
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Contributions

VKV: methodology, formal analysis and investigation, and writing—original draft preparation. VS: conceptualization, methodology, formal analysis and investigation, and resources. TS: methodology, formal analysis, and investigation. AM: conceptualization, methodology, and writing—review and editing. PPP: conceptualization, methodology, and writing—review and editing. VM conceptualization, methodology, and writing—review and editing. SS: conceptualization, methodology, writing—review and editing, resources, and supervision.

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Correspondence to Vibhu Krishnan Viswanathan or Senthil Sambandam.

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Waived (National Inpatient Sample Data).

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Viswanathan, V.K., Sakthivelnathan, V., Senthil, T. et al. Does systemic lupus erythematosus impact the peri-operative complication rates following primary total knee arthroplasty? A national inpatient sample-based large-scale study. Arch Orthop Trauma Surg 143, 3291–3298 (2023). https://doi.org/10.1007/s00402-022-04581-4

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  • DOI: https://doi.org/10.1007/s00402-022-04581-4

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