Complications - Other
Dependent Functional Status is a Risk Factor for Perioperative and Postoperative Complications After Total Hip Arthroplasty

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Abstract

Background

As the population ages, the need for total hip arthroplasty (THA) will increase. However, this will be associated with an increase in comorbidities and a decrease in the ability to independently perform activities of daily living (ADLs). This study was designed to evaluate the impact preoperative functional status has on short-term outcomes after THA.

Methods

Primary THAs performed from 2012 to 2016 were identified in the National Surgical Quality Improvement Program database. Final analysis included 115,590 cases. Patients who could perform all ADLs were classified as independent functional status (n = 113,436), and patients requiring assistance with ADLs were classified as dependent functional status (n = 2154). Univariate analysis was used to compare perioperative outcomes and 30-day complication rates. Multivariate regression was then applied to determine if preoperative dependent functional status was an independent risk factor for adverse outcomes.

Results

Functionally dependent patients were more likely to experience operative times >120 minutes (odds ratio [OR] = 1.39; P < .001), hospital stays >10 days (OR = 2.96; P < .001), and nonhome discharge (OR = 2.53; P < .001). Dependent functional status was also an independent risk factor for mortality (OR = 3.00; P = .001), reoperation (OR = 1.39; P = .015), readmission (OR = 1.75; P < .001), superficial surgical site infection (OR = 1.96; P = .002), wound dehiscence (OR = 2.72; P = .034), pneumonia (OR = 2.16; P = .001), reintubation (OR = 2.31; P = .007), prolonged ventilator use (OR = 3.01; P = .009), renal failure necessitating dialysis (OR = 3.94; P = .002), urinary tract infection (OR = 1.78; P = .001), blood transfusion (OR = 1.75; P < .001), and sepsis (OR = 2.38; P = .001).

Conclusions

Functionally dependent patients undergoing THA are at higher risk of mortality, adverse perioperative outcomes, and complications. These data may aid for patient counseling and risk stratification.

Section snippets

Database

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was accessed for use in this study. This database receives information from over 500 hospitals nationwide which prospectively collect data using trained medical chart reviewers [18], [19]. Patient demographics, comorbidities, preoperative laboratory values, and 30-day complication rates are all reported. The methods used by the ACS NSQIP database have been largely discussed in previous

Results

Overall, patients who were functionally dependent before surgery were more likely to experience adverse perioperative outcomes (Table 3). Compared with functionally independent patients, functionally dependent patients were more likely to have prolonged surgeries lasting longer than 120 minutes (odds ratio [OR] = 1.39; 95% confidence interval [CI] 1.24-1.56; P < .001) and prolonged lengths of stay lasting more than 10 days (OR = 2.96; 95% CI 2.09-4.18; P < .001). Dependent patients were also

Discussion

The primary purpose of this study was to analyze the relationship between preoperative functional status and short-term surgical outcomes in patients undergoing primary THA. Previous literature has assessed preoperative functional status's relationship to functional outcomes after TJA, but there is a lack of literature regarding its impact on postoperative morbidity and mortality. This is the first investigation to study the association between preoperative functional status and adverse events

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    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.12.037.

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