title: Comorbidities increase complication rates in patients having arthroplasty.
abstract: The objective of our study was to assess the effect of comorbidities (hypertension, diabetes, obesity, and their combinations) on postoperative complications and discharge status in patients having shoulder, hip, and knee arthroplasty (n = 959,839). The association between outcomes and each of the comorbidities was assessed using multivariable logistic regression after adjusting for age, race, household income, gender, and hospital volume. In the multivariable models, postoperative complications were more likely in patients with hypertension, diabetes, or obesity as compared with patients without these comorbidities (for hypertension, odds ratio = 1.07; 95% confidence interval range, 1.04-1.11; for obesity, odds ratio = 1.3; 95% confidence interval range, 1.22-1.41). The likelihood of a nonhomebound disposition of patients on discharge was 1.30 times (95% confidence interval range, 1.27-1.32) in patients with diabetes and 1.45 times (95% confidence interval range, 1.40-1.49) in patients who were obese as compared with patients without these respective comorbidities. Patients with a combination of comorbidities also had a higher likelihood of postoperative complications and nonhomebound discharge. Results of our study showed that hypertension, diabetes, and obesity are independent predictors of increased postoperative complications and non-homebound discharge in patients undergoing shoulder, hip, or knee arthroplasty.
  
  
  METHODS
  Prognostic study, Level II-1 (retrospective study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Center for Excellence in Surgical Outcomes, Duke University Medical Center, Durham, NC, USA. nitin_jain@hms.harvard.edu
authors.forename: Nitin B
authors.initials: NB
authors.lastname: Jain
authors.forename: Ulrich
authors.initials: U
authors.lastname: Guller
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Bond
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Higgins
mesh_terms: D000368:Aged; D019643:Arthroplasty, Replacement; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012307:Risk Factors