Morbid Obesity in Total Hip Arthroplasty: Redefining Outcomes for Operative Time, Length of Stay, and Readmission

Background: Long operative times in total hip arthroplasty (THA) have been shown to be associated with increased risk of revision as well as perioperative morbidity. This study assesses the effect of extended operative times on complication rates following primary THA using the most recent national data. Methods: The National Surgical Quality Improvement Program (NSQIP) database (2008–2016) was queried for primary THA. Groups were defined by operative time 1 standard deviation (1 SD) above the mean. Univariate, propensity score-matched, and multivariate logistic regression analyses were performed to evaluate outcomes. Results: Data was available for 135,013 THA patients. Among these groups, mean operative time in the extended operative time group was 166 minutes (compared with 82 minutes). Patients undergoing longer operative times were 3.8 years younger, had a 1.5 kg/m2 higher body mass index and had a 0.5 day longer mean length of stay. Propensity matching identified 16,123 pairs for analysis in the 1 SD group. Longer operative time led to 173% increased risk of major medical morbidity, 140% increased likelihood of length of stay greater than 5 days, 59% increased risk of reoperation, 45% increased risk of readmission, and a 30% decreased likelihood of return to home postoperatively. There was no increased risk of death within 30 days. Conclusion: Long operative times were associated with increases in multiple postoperative complications, but not mortality. Surgeons should be advised to take steps to minimise operative time by adequate preoperative planning and optimal team communication.

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Morbid Obesity and Congestive Heart Failure Increase Operative Time and Room Time in Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2015.10.032 ◽

2016 ◽

Vol 31 (4) ◽

pp. 771-775 ◽

Cited By ~ 10

Author(s):

J. Joseph Gholson ◽

Apurva S. Shah ◽

Yubo Gao ◽

Nicolas O. Noiseux

Keyword(s):

Heart Failure ◽

Morbid Obesity ◽

Congestive Heart Failure ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Operative Time ◽

Total Hip ◽

Room Time

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Total hip arthroplasty through an anterior approach

EFORT Open Reviews ◽

10.1302/2058-5241.3.180023 ◽

2018 ◽

Vol 3 (11) ◽

pp. 574-583 ◽

Cited By ~ 12

Author(s):

Georgios Kyriakopoulos ◽

Lazaros Poultsides ◽

Panayiotis Christofilopoulos

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Anterior Approach ◽

Formal Training ◽

Long Term Outcomes ◽

Medium Term ◽

Total Hip

Total hip arthroplasty through an anterior approach has been increasing in popularity amongst surgeons and patients. Anterior approach hip arthroplasty seems to offer improved early outcomes in terms of pain, rehabilitation and length of stay. No difference in long-term outcomes has been shown between anterior and posterior or lateral approaches. Proper formal training, utilization of fluoroscopy and adequate experience can mitigate risks of complications and improve early and medium-term outcomes. Cite this article: EFORT Open Rev 2018;3:574-583. DOI: 10.1302/2058-5241.3.180023.

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Evidence-Based Thresholds for the Volume and Length of Stay Relationship in Total Hip Arthroplasty: Outcomes and Economies of Scale

The Journal of Arthroplasty ◽

10.1016/j.arth.2018.01.059 ◽

2018 ◽

Vol 33 (7) ◽

pp. 2031-2037 ◽

Cited By ~ 15

Author(s):

Prem N. Ramkumar ◽

Sergio M. Navarro ◽

William C. Frankel ◽

Heather S. Haeberle ◽

Ronald E. Delanois ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Length Of Stay ◽

Hip Arthroplasty ◽

Economies Of Scale ◽

Evidence Based ◽

Total Hip

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Early Surgical Complications of Total Hip Arthroplasty in Patients With Morbid Obesity: Propensity-Matched Cohort Study of 3683 Patients

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.04.044 ◽

2020 ◽

Vol 35 (9) ◽

pp. 2646-2651

Author(s):

Hosam E. Matar ◽

Daniel Pincus ◽

J. Michael Paterson ◽

Suriya Aktar ◽

Richard Jenkinson ◽

...

Keyword(s):

Morbid Obesity ◽

Cohort Study ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Surgical Complications ◽

Matched Cohort ◽

Total Hip ◽

Matched Cohort Study

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Neuraxial anaesthesia is associated with improved outcomes and reduced postoperative complications in patients undergoing aseptic revision total hip arthroplasty

Hip International ◽

10.1177/1120700020975749 ◽

2020 ◽

pp. 112070002097574

Author(s):

Chapman Wei ◽

Alex Gu ◽

Arun Muthiah ◽

Safa C Fassihi ◽

Peter K Sculco ◽

...

Keyword(s):

Postoperative Complications ◽

Total Hip Arthroplasty ◽

Length Of Stay ◽

General Anaesthesia ◽

Hip Arthroplasty ◽

Postoperative Outcomes ◽

Complication Rates ◽

Total Hip ◽

Neuraxial Anaesthesia ◽

Extended Length

Background: As the incidence of primary total hip arthroplasty (THA) continues to increase, revision THA (rTHA) is becoming an increasingly common procedure. rTHA is widely regarded as a more challenging procedure, with higher complication rates and increased medical, social and economic burdens when compared to its primary counterpart. Given the complexity of rTHA and the projected increase in incidence of these procedures, patient optimisation is becoming of interest to improve outcomes. Anaesthetic choice has been extensively studied in primary THA as a modifiable risk factor for postoperative outcomes, showing favourable results for neuraxial anaesthesia compared to general anaesthesia. The impact of anaesthetic choice in rTHA has not been studied previously. Methods: A retrospective study was performed using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent rTHA between 2014 and 2017 were divided into 3 anaesthesia cohorts: general anaesthesia, neuraxial anaesthesia, and combined general-regional (neuraxial and/or peripheral nerve block) anaesthesia. Univariate and multivariate analyses were used to analyse patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post-hoc analysis. Results: In total, 5759 patients were identified. Of these, 3551 (61.7%) patients underwent general anaesthesia, 1513 (26.3%) patients underwent neuraxial anaesthesia, and 695 (12.1%) patients underwent combined general-regional anaesthesia. On multivariate analysis, neuraxial anaesthesia was associated with decreased odds for any-one complication (OR 0.635; p < 0.001), perioperative blood transfusion (OR 0.641; p < 0.001), and extended length of stay (OR 0.005; p = 0.005) compared to general anaesthesia. Conclusions: Relative to those receiving general anaesthesia, patients undergoing neuraxial anaesthesia are at decreased risk for postoperative complications, perioperative blood transfusions, and extended length of stay. Prospective controlled trials should be conducted to verify these findings.

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