How Much Do Adverse Event Rates Differ Between Primary and Revision Total Joint Arthroplasty?
BACKGROUND
It is not known which adverse events occur more commonly following revision than following primary total joint arthroplasty.


METHODS
Patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) during 2011 to 2013 as part of the America College of Surgeons National Surgical Quality Improvement Program were identified. Rates of adverse events were compared between patients undergoing primary and patients undergoing revision procedures with adjustments for demographic and comorbidity characteristics.


RESULTS
In total, 48307 THA patients and 70605 TKA patients met inclusion criteria. Of the THA patients, 43247 (89.5%) underwent primary procedures, while 5060 (10.5%) underwent revision procedures. Of the TKA patients, 65694 (93.0%) underwent primary procedures, while 4911 (7.0%) underwent revision procedures. Patients undergoing revision procedures had higher rates of systemic sepsis (for THA, 0.3% vs 0.1%, adjusted relative risk [RR], 3.5; 95% confidence interval [CI], 1.7-7.0; P < .001; for TKA, 0.3% vs 0.1%, adjusted RR, 3.0; 95% CI, 1.7-5.2, P < .001), deep incisional surgical site infection (for THA, 1.3% vs 0.3%, adjusted RR, 4.3; 95% CI, 3.2-5.8, P < .001; for TKA, 0.7 vs 0.2%, RR, 4.0; 95% CI, 2.7-5.9, P < .001), and organ/space infection (for THA, 1.8% vs 0.2%, RR, 7.4; 95% CI, 5.4-10.0, P < .001; for TKA, 1.1% vs 0.1%, adjusted RR, 7.5; 95% CI, 5.4-10.6, P < .001). Patients undergoing revision procedures did not have higher rates of pulmonary embolism or deep vein thrombosis (P ≥ .05 for each).


CONCLUSIONS
Public reporting of adverse events should be interpreted in the context of the differences between primary and revision procedures, and reimbursement systems should reflect the greater amount of postoperative care that patients undergoing revision procedures require.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Daniel D
DD
Bohl
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Andre M
AM
Samuel
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Bryce A
BA
Basques
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Craig J
CJ
Della Valle
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.
Brett R
BR
Levine
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Jonathan N
JN
Grauer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D011787:Quality of Health Care; D012086:Reoperation / Q000009:adverse effects*; D012189:Retrospective Studies; D012306:Risk; D012955:Societies, Medical; D013530:Surgical Wound Infection / Q000209:etiology*; D014481:United States; D055815:Young Adult
Adverse events; Complications; Primary total hip arthroplasty; Primary total knee arthroplasty; Revision total hip arthroplasty; Revision total knee arthroplasty