Perioperative outcomes in patients with rheumatoid versus osteoarthritis for total hip arthroplasty: a population-based study.
OBJECTIVE
Little is known about perioperative outcomes among the subset of patients undergoing total hip arthroplasty (THA) for a diagnosis of rheumatoid arthritis (RA) rather than osteoarthritis (OA). We sought to 1) identify the prevalence of RA in patients undergoing THA, 2) compare their demographics to those being operated on for OA, 3) determine differences in perioperative outcomes and 4) analyse if RA represents an independent risk factor for complications, mortality, utilisation of resources, increased length of stay and cost.


METHODS
Entries of patients who underwent elective THA between 2006 and 2010 were identified in a national database and subgrouped according to presence of a concurrent diagnosis of RA. Differences in demographics and perioperative outcomes were analysed.


RESULTS
We identified 157,775 entries for patients who underwent THA between 2006 and 2010. RA was present in 3.42% (n=5,400). Patients in the group RA were on average younger [RA: 63.94 years vs. OA: 65.64 years; p<0.0001] and more likely female [RA: 75.47% vs. OA: 56.09%; p<0.0001]. While mortality was not statistically different, perioperative pulmonary and infectious complications occurred more frequently in RA patients. Compared with OA, multivariate logistic regression revealed higher overall odds for complications [OR=1.15 (CI 1.05;1.25), p=0.0037], need for mechanical ventilation [OR=1.42 (CI 1.01;2.00), p=0.0414], transfusion [OR=1.35 (CI 1.26;1.44), p<0.0001], prolonged hospitalisation [OR=1.16 (CI 1.08;1.23), p<0.0001] and increased hospital charges [OR=1.17 (CI 1.09;1.26), p<0.0001].


CONCLUSIONS
In THA patients suffering from RA, perioperative risk for complications and utilization of health care resources continues to be increased compared to OA patients.
Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, USA. otto.stundner@gmail.com.
Ottokar
O
Stundner
Ya-Lin
YL
Chiu
Xuming
X
Sun
Susan M
SM
Goodman
Linda A
LA
Russell
James J
JJ
Calloway
C Ronald
CR
MacKenzie
Madhu
M
Mazumdar
Stavros G
SG
Memtsoudis
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D017722:Hospital Charges; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D015207:Osteoarthritis, Hip / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology