title: Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers.
abstract: The influence of drug misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent primary THA or TKA between 1990 and 2007. Patients were divided into two groups: 1) those with a diagnosis of drug misuse (cannabis, opioids, cocaine, amphetamines, sedatives, inhalants or mixed combinations) (n=13,163) and 2) those with no diagnosis of misuse (n=8,366,327). Patients with a diagnosis of drug misuse had longer hospital stays (P<0.001), nearly eight times the odds of leaving against medical advice (P<0.001) and five times the mortality rate (P<0.001). Drug misuse was associated with higher odds (P<0.001) of complications including postoperative infection, anemia, convulsions, osteomyelitis, and blood transfusion.
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Miami, Florida.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Best
authors.affiliation: University of Miami Miller School of Medicine, Department of Orthopaedic Surgery and Rehabilitation, Miami, Florida.
authors.forename: Leonard T
authors.initials: LT
authors.lastname: Buller
authors.affiliation: Cleveland Clinic Department of Orthopaedic Surgery, Mail Code A41,Cleveland, Ohio.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Cleveland Clinic Department of Orthopaedic Surgery, Mail Code A41,Cleveland, Ohio.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010019:Osteomyelitis / Q000209:etiology; D010351:Patient Discharge; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D012640:Seizures / Q000209:etiology; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
keywords: abuse; drug; drug dependence; drug misuse; total hip arthroplasty; total knee arthroplasty