Readmission for Early Prosthetic Dislocation after Primary Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 023-032
Author(s):  
Wesley M. Durand ◽  
William J. Long ◽  
Ran Schwarzkopf
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Operating Room ◽  
Hip Arthroplasty ◽  
Postoperative Management ◽  
Chronic Obstructive ◽  
Improvement Program ◽  
Obstructive Pulmonary Disease ◽  
Total Hip ◽  
Early Reoperation

AbstractProsthetic dislocation in total hip arthroplasty (THA) is the most common cause for readmission in the 90 days following surgery. This investigation sought to quantify risk factors for readmission for early prosthetic dislocation within 30 days after primary THA. This study used the National Surgical Quality Improvement Program (NSQIP) database for the years 2012 to 2017. The primary outcome was reoperation or readmission for prosthetic dislocation within 30 days after primary total hip replacement. Secondary outcomes included native NSQIP medical complications. A total of 159,234 patients were included. Of these, 0.25% (n = 399) experienced reoperation or readmission for prosthetic dislocation within 30 days postoperatively. A total of 217 dislocated hips (54.4%) returned to the operating room only once, and 27 hips (6.8%) returned to the operating room twice. The mean day of first reoperation/readmission for dislocation was 13.5 (standard deviation [SD]: 9.0). In multivariable logistic regression, the following factors were significantly associated with early reoperation/readmission for prosthetic dislocation: patient age 80+ years (odds ratio [OR]: 1.51 vs. 50–59), high creatinine (OR: 1.75 vs. normal range), smoking (OR: 1.53), history of severe chronic obstructive pulmonary disease (COPD) (OR: 1.73), general anesthesia (OR: 1.41 vs. spinal), American Society of Anesthesiologists (ASA) class 3–5 (OR: 1.66 vs. 1 or 2), fracture (OR: 2.17), chronic steroid use (OR: 1.54), and operative duration ≥ 2 hours (all p < 0.05). Early prosthetic dislocation was significantly associated with the further development of surgical site infection (OR: 2.25) (both p < 0.05). This study identified risk factors for early reoperation/readmission for prosthetic dislocation after THA. These findings have implications for preoperative planning, postoperative management, and dislocation precautions.

scholarly journals Risk Factors for Blood Transfusion After Primary Total Hip Arthroplasty

2019 ◽  
Vol 9 ◽  
Author(s):  
Kyle K. Kesler ◽  
Timothy S. Brown ◽  
J. Ryan Martin ◽  
Bryan D. Springer ◽  
Jesse Otero
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Total Hip Arthroplasty ◽  
Blood Transfusion ◽  
Hip Arthroplasty ◽  
Univariate Analysis ◽  
Chronic Obstructive ◽  
Complication Rates ◽  
Improvement Project ◽  
Total Hip

Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions.  This testing adds cost and may not be necessary in most patients.  This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database.  Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion. Results: Overall, 28664 patients who underwent THA patients were identified.  Within this group, 6.1% (n=1737) had a post-operative transfusion.  Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p<0.001).  Univariate analysis demonstrated that patients requiring transfusion had higher complication rates (4.3% vs. 12.8%, p<0.0001).  Multivariate analysis identified age >70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion.  Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA. 

Chronic Obstructive Pulmonary Disease Is Associated With Short-Term Complications Following Total Hip Arthroplasty

2018 ◽  
Vol 33 (6) ◽  
pp. 1926-1929 ◽  
Author(s):  
George A. Yakubek ◽  
Gannon L. Curtis ◽  
Nipun Sodhi ◽  
Mhamad Faour ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Total Hip Arthroplasty ◽  
Pulmonary Disease ◽  
Hip Arthroplasty ◽  
Chronic Obstructive ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Total Hip

Risk Factors for Early Periprosthetic Fracture after Primary Total Hip Arthroplasty

2020 ◽  
Vol 04 (01) ◽  
pp. 038-044
Author(s):  
Wesley M. Durand ◽  
Morteza Meftah ◽  
Ran Schwarzkopf
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Periprosthetic Fracture ◽  
Multivariable Analysis ◽  
Adverse Outcomes ◽  
Improvement Program ◽  
Surgical Quality ◽  
Total Hip ◽  
Significant Difference

AbstractPeriprosthetic fracture (PPF) after total hip arthroplasty (THA) is associated with adverse outcomes. Many studies have sought to determine risk factors for PPF, though controversy exists regarding several variables. This study sought to determine risk factors for early PPF using the National Surgical Quality Improvement Program (NSQIP) dataset. Patients with a primary current procedural terminology for THA were identified. The primary outcome was reoperation/readmission for PPF within 30 days. Multivariable logistic regression was utilized to adjust for confounding factors. A total of 159,234 patients were included in the study, of whom 195 patients (0.12%) had a PPF within 30 days, with a mean day of reoperation/readmission of 14.6 (standard deviation 7.7). A total of 68 patients (34.9% of those fractured) underwent one or more reoperations. In multivariable analysis, risk factors for PPF were higher body mass index (BMI; odds ratio [OR] 1.03 per mg/kg2, 95% confidence interval [CI] 1.0–1.05) and higher preoperative leukocyte count (OR 1.04 per 103/mL, 95% CI 1.01–1.06). Among females, age (OR 1.05 per year, 95% CI 1.04–1.07) was significantly associated with PPF, but a similar difference was not observed among males (OR 1.01, 95% CI 0.98–1.04). Controlling for patient age, there was no significant difference in risk of PPF for females versus males (p = 0.2213). PPF was associated with the development of additional complications (OR 4.10, 95% CI 2.68–6.27). This study identified risk factors for PPF after primary THA. These results have implications for preoperative planning and postoperative precautions among patients with particularly elevated risk of PPF.

scholarly journals Risk Factors for Discharge to a Non-Home Destination and Reoperation Following Outpatient Total Hip Arthroplasty (THA) in Medicare-Eligible Patients

2021 ◽  
Vol 12 ◽  
pp. 215145932199150
Author(s):  
Adam M. Gordon ◽  
Azeem Tariq Malik ◽  
Safdar N. Khan
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Care Facility ◽  
Discharge Destination ◽  
Improvement Program ◽  
Factors Associated ◽  
Total Hip ◽  
Home Discharge ◽  
Independent Risk Factors

Introduction: The Centers for Medicare and Medicaid Services removed total hip arthroplasty (THA) from the inpatient-only (IO) list in January 2020. Given this recommendation, we analyzed Medicare-eligible patients undergoing outpatient THA to understand risk factors for nonroutine discharge, reoperations, and readmissions. Materials and Methods: The 2015-2018 American College of Surgeons–National Surgical Quality Improvement Program database was queried using Current Procedural Terminology code 27130 for Medicare eligible patients (≥ 65 years of age) undergoing outpatient THA. Postoperative discharge destination was categorized into home and non-home. Multivariate logistic regression models were used to evaluate risk factors associated with non-home discharge disposition. Secondarily, we evaluated rates and risk factors associated with 30-day reoperations and readmissions. Results: A total of 1095 THAs were retrieved for final analysis. A total of 108 patients (9.9%) experienced a non-home discharge postoperatively. Patients were discharged to rehab (n = 47; 4.3%), a skilled care facility (n = 47; 4.3%), a facility that was “home” (n = 8; 0.7%), a separate acute care facility (n = 5; 0.5%), or an unskilled facility (n = 1; 0.1%). Independent factors for a non-home discharge were American Society of Anesthesiologists Class >II (odds ratio [OR] 2.74), operative time >80 minutes (OR 2.42), age >70 years (OR 2.20), and female gender (OR 1.67). Eighteen patients (1.6%) required an unplanned reoperation within 30 days. A total of 40 patients (3.7%) required 30-day readmissions, with 35 readmissions related to the original THA procedure. Independent risk factors for 30-day reoperation were COPD (OR 5.85) and HTN (OR 5.24). Independent risk factors for 30-day readmission were HTN (OR 4.35) and Age >70 (OR 2.48). Discussion: The current study identifies significant predictors associated with a non-home discharge, reoperation, and readmission in Medicare-aged patients undergoing outpatient THA. Conclusion: Providers should consider preoperatively risk-stratifying patients to reduce the costs associated with unplanned discharge destination, complication or reoperation.

scholarly journals Total hip arthroplasty and chronic obstructive pulmonary disease in a high dependency unit

2017 ◽  
Vol 3 (3b) ◽  
pp. 101-103
Author(s):  
Leonidas Grigorakos ◽  
Katerina Sakagianni ◽  
Mariza Gioka ◽  
Victoria Charizopoulou ◽  
Dimitra Markopoulou ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Total Hip Arthroplasty ◽  
Pulmonary Disease ◽  
Hip Arthroplasty ◽  
Chronic Obstructive ◽  
High Dependency Unit ◽  
Obstructive Pulmonary Disease ◽  
Total Hip ◽  
High Dependency

Epidemiological Study of Femoral Head Osteonecrosis

2017 ◽  
Vol 68 (5) ◽  
pp. 974-976
Author(s):  
Alexandru Patrascu ◽  
Liliana Savin ◽  
Dan Mihailescu ◽  
Victor Grigorescu ◽  
carmen Grierosu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Young Patients ◽  
Head Group ◽  
Bipolar Hemiarthroplasty ◽  
Aseptic Necrosis ◽  
Total Hip ◽  
Femoral Head Osteonecrosis

In recent years, there has been an increase in the number of studies on the etiology of femoral head necrosis. We retrospectively reviewed all patients diagnosed with aseptic necrosis of the femoral in the period of 2010-2015. We recorded a total of 230 cases diagnosed with aseptic necrosis of the femoral head, group was composed of 65.7% men and 34.3% women, risk factors identified was 19.13% (post-traumatic), 13.91% (glucocorticoids), 26.52% (alcohol), 3.47% (another cause) and in 36 95% of the cases no risk factors were found. The results of the study based on the type of surgery performed on the basis of stages of disease progression, 8 patients (3.48%) benefited from osteotomy, 28 patients (12.17%) benefited of bipolar hemiarthroplasty prosthesis and 188 patients (81.74%) benefited of total hip arthroplasty. Osteonecrosis of the femoral head is characteristic to young patients between the age of 30-50 years old. Predisposing factors, alcohol and corticosteroid therapy remains an important cause of the disease. Total hip arthroplasty remains the best option for the patients with osteonecrosis of the femoral head.

scholarly journals Risk factors in total hip arthroplasty and hemiarthroplasty: Infection and mortality

2021 ◽  
Vol 65 (4) ◽  
pp. 239-247
Author(s):  
A. Hernández-Aceituno ◽  
M. Ruiz-Álvarez ◽  
R. Llorente-Calderón ◽  
P. Portilla-Fernández ◽  
A. Figuerola-Tejerina
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip
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