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Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study

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Abstract

Purpose

The occurrence of prosthesis-related complications (PRCs) after total hip arthroplasty (THA) is devastating, commonly meaning implant failure and revision surgery. The purpose was to examine the incidence and risk factors of in-hospital PRCs following THA using a large-scale national database.

Methods

A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2005 to 2014. Patients who underwent THA were included. Patient demographics, hospital characteristics, length of stay (LOS), economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.

Results

A total of 590,122 THAs were obtained from the NIS database. The general incidence of in-hospital PRCs after THA was 1.96%, with a slight downward trend annually. Dislocation was the most common PRCs (0.23%). Patients with PRCs after THA demonstrated increased LOS, total charges, usage of Medicare, and in-hospital mortality. Risk factors of PRCs included advanced age, female, the Hispanic, the Native American, large hospital, teaching hospital, hospital in the South, Medicaid, Self-pay, alcohol abuse, anemia, coagulopathy, rheumatoid diseases, neurological disorders, depression, paralysis, psychosis, diabetes, fluid and electrolyte disorders, congestive heart failure, chronic pulmonary disease, liver disease, metastatic cancer, and weight loss. Additionally, PRCs were associated with avascular necrosis, ankylosing spondylitis, rheumatoid arthritis, femoral neck fracture, dementia, osteoporosis, acute renal failure, acute myocardial infarction, pneumonia, post-operative delirium, urinary tract infection, deep vein thrombosis, transfusion, sepsis, post-operative shock, wound dehiscence, haemorrhage/seroma/haematoma, and nerve injury.

Conclusion

A relatively low incidence of in-hospital PRCs after THA was identified. It is of benefit to study risk factors of PRCs to ensure the appropriate management and moderate consequences.

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Data availability

This study is based on data provided by Nationwide Inpatient Sample (NIS) database, part of the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. The NIS database is a large publicly available all-payer inpatient care database in the USA. Therefore, individual or grouped data cannot be shared by the authors.

Abbreviations

THA:

total hip arthroplasty

THR:

total hip revision

PRCs:

prosthesis-related complications

PJI:

periprosthetic joint infection

PPF:

periprosthetic fracture

LOS:

length of stay

NIS:

Nationwide Inpatient Sample

ICD-9-CM:

International Classification of Diseases (ninth revision) Clinical Modification

OR:

odds ratio

CI:

confidence interval

AVN:

avascular necrosis

AS:

ankylosing spondylitis

RA:

rheumatoid arthritis

FNF:

femoral neck fracture

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Author notes

  1. Qinfeng Yang and Jian Wang contributed equally to this work.

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue, Guangzhou, 510515, Guangdong, China

    Qinfeng Yang, Jian Wang, Yichuan Xu, Yuhang Chen, Qiang Lian & Yang Zhang

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  1. Qinfeng Yang
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  2. Jian Wang
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  3. Yichuan Xu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection ,and analysis were performed by Jian Wang, Yichuan Xu, Yuhang Chen, and Qiang Lian. The first draft of the manuscript was written by Qinfeng Yang with revision, guidance, and feedback from Yang Zhang, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Yang Zhang.

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This article does not contain any studies with human participants or animals performed by any of the authors. This observational study was deemed exempt because it used deidentified publicly available data.

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Yang, Q., Wang, J., Xu, Y. et al. Incidence and risk factors of in-hospital prosthesis-related complications following total hip arthroplasty: a retrospective Nationwide Inpatient Sample database study. International Orthopaedics (SICOT) 44, 2243–2252 (2020). https://doi.org/10.1007/s00264-020-04682-y

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