Incidence And Risk Factors Of In-Hospital Prosthesis-Related Complications Following Total Hip Arthroplasty

PurposeThe occurrence of prosthesis-related complications(PRCs)after total hip arthroplasty(THA)is devastating,commonly meaning implant failure and revision surgeries.The purpose was to examine the incidence and risk factors of in-hospital PRCs following THA using a large-scale national database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample(NIS)from 2005-2014.Patients who underwent THA with available hospitalized information provided by NIS database were included and analyzed.Patients were excluded if they were less than 18 years of age,had osteomyelitis,or had pathologic fracture.The recruited cases were divided into two groups according to the occurrence of PRCs.Patient demographics(age,sex,and race),hospital characteristics(type of admission and payer,and bedsize,teaching status,location,and region of hospital),length of stay,economic indicators(total charges during hospitalization,type of payer,median household income),in-hospital mortality,preoperative comorbidities,and perioperative complications were evaluated by independent t test for continuous data and chi-square test for categorical data.Logistic regression was applied to identify risk factors of in-hospital PRCs after THA.ResultsA total of 590,122 THAs were obtained from the NIS database.There were 11,573 cases of in-hospital PRCs following THA and the general incidence was 1.96%,with a slight downward trend annually.Dislocation was the most common PRCs(0.23%),closely followed by periprosthetic joint infection(0.20%),periprosthetic fracture(0.11%)and mechanical loosening(0.09%).Patients undergoing THA with the occurrence of in-hospital PRCs demonstrated extended length of stay(4 days vs.3 days;P<0.0001),increased total charges($61,339 vs.$43,994,P<0.0001),more usage of Medicare(63.45%vs.52.45%;P<0.0001),and higher in-hospital mortality(0.92%vs.0.14%;P<0.0001).Independent risk factors of in-hospital PRCs following THA included advanced age(≥75 years),female,the Hispanic,the Native American,large hospital,teaching hospital,hospital in the South,Medicaid,Self-pay,alcohol abuse,deficiency anemia,chronic blood loss anemia,coagulopathy,rheumatoid diseases,neurological disorders,depression,paralysis,psychosis,diabetes,fluid and electrolyte disorders,congestive heart failure,chronic pulmonary disease,liver disease,metastatic cancer,weight loss,avascular necrosis,ankylosing spondylitis,rheumatoid arthritis,femoral neck fracture,dementia,and osteoporosis.Additionally,PRCs were associated with several perioperative complications including acute renal failure,acute myocardial infarction,pneumonia,postoperative delirium,urinary tract infection,deep vein thrombosis,transfusion,sepsis,postoperative shock,wound dehiscence,hemorrhage/seroma/hematoma,and nerve injury.Besides,elective admission,hospital in the Midwest or North Central,Private insurance,hypertension,and obesity were found to be protective factors of in-hospital PRCs after THA.ConclusionA relatively low incidence of in-hospital PRCs after THA was identified,but the occurrence of these catastrophic complications usually cause a variety of severe consequences.It is of benefit to study risk factors of PRCs to ensure the appropriate management and moderate consequences.