The Use of Older Versus Newer Data in the National Surgical Quality Improvement Program Database Influences the Results of Total Hip Arthroplasty Outcomes Studies

AbstractThe relationship between preoperative hyponatremia and 30-day outcomes following total hip arthroplasty (THA) is currently unknown. The present study used prospectively collected data to quantify the association between preoperative hyponatremia and odds of major morbidity (MM), longer length of stay, readmission, and reoperation within 30 days following THA. Patients who underwent THA between 2012 and 2014 were identified in the National Surgical Quality Improvement Program database using validated Current Procedural Terminology codes. Patients were included if they were either normonatremic or hyponatremic preoperatively. The outcome measures in this study were 30-day MM, hospital length of stay, 30-day readmission, and 30-day reoperation. A unique multivariable logistic regression model was used for each outcome to identify statistically significant associations between hyponatremia and the outcome of interest after adjusting for covariates. From 2012 to 2014, 59,236 THA procedures were recorded in National Surgical Quality Improvement Program, of which 55,611 patients were normonatremic and 3,051 patients were hyponatremic. After adjusting for covariates, preoperative hyponatremia was significantly associated with increased odds of MM (odds ratio [OR] = 1.14; 99% confidence interval [CI]: 1.01–1.30), 30-day reoperation (OR = 1.18; 99% CI: 1.02–1.36), and longer hospital length of stay (OR = 1.20; 99% CI: 1.13–1.27). Hyponatremia was not significantly associated with greater odds of 30-day readmission (OR = 0.91; 99% CI: 0.82–1.01). Preoperative hyponatremia was significantly associated with adverse 30-day outcomes following THA. As the U.S. health care system continues to transition toward value-based reimbursement that emphasizes health care quality, the results of the present study can be used to improve patient selection and preoperative counseling.

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Open reduction internal fixation versus hemiarthroplasty versus total hip arthroplasty in the elderly: a review of the National Surgical Quality Improvement Program database

Journal of Surgical Research ◽

10.1016/j.jss.2012.07.004 ◽

2013 ◽

Vol 181 (2) ◽

pp. 193-198 ◽

Cited By ~ 23

Author(s):

Michael A. Fisher ◽

Jarrod D. Matthei ◽

Augustine Obirieze ◽

Gezzer Ortega ◽

Daniel D. Tran ◽

...

Keyword(s):

Quality Improvement ◽

Total Hip Arthroplasty ◽

Internal Fixation ◽

Hip Arthroplasty ◽

Open Reduction ◽

The Elderly ◽

Open Reduction Internal Fixation ◽

Improvement Program ◽

Surgical Quality ◽

Total Hip

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Duration of surgery affects the risk of complications following total hip arthroplasty

The Bone & Joint Journal ◽

10.1302/0301-620x.101b6.bjj-2018-1400.r1 ◽

2019 ◽

Vol 101-B (6_Supple_B) ◽

pp. 51-56

Author(s):

L. L. Nowak ◽

E. H. Schemitsch

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Operating Time ◽

Improvement Program ◽

Surgical Quality ◽

Total Hip ◽

Major Complications ◽

Duration Of Surgery ◽

American College Of Surgeons ◽

Multivariable Regression

Aims The aim of this study was to assess the influence of operating time on 30-day complications following total hip arthroplasty (THA). Patients and Methods We identified patients aged 18 years and older who underwent THA between 2006 and 2016 from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We identified 131 361 patients, with a mean age of 65 years (sd 12), who underwent THA. We used multivariable regression to determine if the rate of complications and re-admissions was related to the operating time, while adjusting for relevant covariables. Results The mean operating time decreased from 118.3 minutes (29.0 to 217.0) in 2006, to 89.6 minutes (20.0 to 240.0) in 2016. After adjustment for covariables, operating times of between 90 and 119 minutes increased the risk of minor complications by 1.2 (95% confidence interval (CI) 1.1 to 1.3), while operating times of between 120 and 179 minutes increased the risk of major complications by 1.4 (95% CI 1.3 to 1.6) and minor complications by 1.4 (95% CI 1.2 to 1.5), and operating times of 180 minutes or more increased the risk of major complications by 2.1 (95% CI 1.8 to 2.6) and minor complications by 1.9 (95% CI 1.6 to 2.3). There was no difference in the overall risk of complications for operating times of between 20 and 39, 40 and 59, or 60 and 89 minutes (p > 0.05). Operating times of between 40 and 59 minutes decreased the risk of re-admission by 0.88 (95% CI 0.79 to 0.97), while operating times of between 120 and 179 minutes, and of 180 minutes or more, increased the risk of re-admission by 1.2 (95% CI 1.1 to 1.3) and 1.6 (95% CI 1.3 to 1.8), respectively. Conclusion These findings suggest that an operating time of more than 90 minutes may be an independent predictor of major and minor complications, as well as re-admission, following THA, and that an operating time of between 40 and 90 minutes may be ideal. Prospective studies are required to confirm these findings. Cite this article: Bone Joint J 2019;101-B(6 Supple B):51–56.

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Patients with insulin-dependent diabetes are at greater risk for perioperative adverse outcomes following total hip arthroplasty

Hip International ◽

10.1177/1120700020988834 ◽

2021 ◽

pp. 112070002098883

Author(s):

Matthew L Webb ◽

Marissa A Justen ◽

Yehuda E Kerbel ◽

Christopher M Scanlon ◽

Charles L Nelson ◽

...

Keyword(s):

Quality Improvement ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Adverse Outcomes ◽

Improvement Program ◽

Total Hip ◽

Increased Risk ◽

Insulin Dependent ◽

Insulin Dependent Diabetic ◽

Insulin Use

Background: The prevalence of diabetes mellitus (DM) continues to increase among patients undergoing total hip arthroplasty (THA). It is unclear how insulin use is correlated with risk for adverse outcomes. Methods: A cohort of 146,526 patients undergoing primary THA were identified in the 2005–2017 National Surgical Quality Improvement Program database. Patients were classified as insulin-dependent diabetic (IDDM), non-insulin-dependent diabetic (NIDDM), or not diabetic. Multivariate analyses were used. Results: Compared to patients without diabetes, patients with NIDDM were at increased risk for 4 of 17 perioperative adverse outcomes studied. Patients with IDDM were at increased risk for those 4 and 8 additional adverse outcomes (12 of the 17 studied). Conclusion: These findings have important implications for preoperative risk stratification and quality improvement initiatives.

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Malnutrition increases the 30-day complication and re-operation rates in hip fracture patients treated with total hip arthroplasty

Hip International ◽

10.1177/1120700019862977 ◽

2019 ◽

Vol 30 (5) ◽

pp. 635-640

Author(s):

Jared M Newman ◽

Nipun Sodhi ◽

Anton Khlopas ◽

Nicolas S Piuzzi ◽

George A Yakubek ◽

...

Keyword(s):

Hip Fracture ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Propensity Scores ◽

Improvement Program ◽

Surgical Quality ◽

Total Hip ◽

Data Regression ◽

Increased Risk ◽

Preoperative Albumin

Introduction: This study sought to determine the effect that malnutrition, defined as hypoalbuminemia, has on hip fracture patients treated with total hip arthroplasty (THA). Specifically, we evaluated: (1) demographics and perioperative data; (2) postoperative complications; and (3) re-operation rates. Methods: The National Surgical Quality Improvement Program database was utilised to identify hip fracture patients who underwent THA from 2008 to 2015. Propensity scores were calculated for the likelihood of having a preoperative albumin measurement. Hip fracture patients who underwent THA and had preoperative hypoalbuminemia (<3.5 g/dL) ( n = 569) were compared to those who had normal albumin levels (⩾3.5 g/dL) ( n = 1098) in terms of demographics and perioperative data. Regression models were adjusted for age, sex, modified Charlson/Deyo scores, and propensity scores to evaluate complication and re-operation rates. Results: Compared to controls, hypoalbuminemia patients were older (p = 0.006), more likely male ( p = 0.024), had higher Charlson/Deyo scores ( p = 0.0001), more likely smokers ( p < 0.0001), more likely functionally dependent ( p < 0.0001), had ASA scores ⩾3 ( p < 0.0001) and had longer LOS ( p < 0.0001). Compared to controls, hypoalbuminemia patients had 80% higher risk for any complication (OR = 1.80; 95% CI, 1.43–2.26), 113% higher risk for major complications (OR = 2.13; 95% CI, 1.31–3.48), and 79% higher risk for minor complications (OR = 1.79; 95% CI, 1.42–2.26), and 97% increased risk for re-operation (OR = 1.97; 95% CI, 1.20–3.23). Conclusions: The findings in the present study indicate the need to develop better pre- and postoperative medical and nutritional care for malnourished hip fracture patients who undergo THA in order to potentially mitigate their increased risk.

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Risk Factors for Early Periprosthetic Fracture after Primary Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0040-1709183 ◽

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.

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