title: Does Chronic Corticosteroid Use Increase Risks of Readmission, Thromboembolism, and Revision After THA?
abstract: BACKGROUND
  Systemic corticosteroids are commonly used to treat autoimmune and inflammatory diseases, but they can be associated with various musculoskeletal problems and disorders. There currently is a limited amount of data describing the postoperative complications of THA associated specifically with chronic corticosteroid use.
  
  
  OBJECTIVE
  For chronic corticosteroid users undergoing THA, we asked: (1) What is the risk of hospital readmission at 30 and 90 days after surgery? (2) What is the risk of venous thromboembolism at 30 and 90 days after surgery? (3) What is the risk of revision hip arthroplasty at 12 and 24 months after surgery?
  
  
  METHODS
  We identified patients in the Statewide Planning and Research Cooperative System who underwent primary THA between January 2003 and December 2010. This database provides hospital discharge abstracts for all admissions in the state of New York each year. We used propensity scores to three-to-one match the 402 chronic corticosteroid users with a comparison cohort of 1206 patients according to age, sex, race, comorbidity score, year of surgery, and hip osteonecrosis. The risk of each outcome was compared between chronic corticosteroid users and the matched cohort. Because multiple comparisons were made, we considered p less than 0.008 as statistically significant.
  
  
  RESULTS
  Readmission was more common for corticosteroid users at 30 days (odds ratio [OR], 1.45; 95% CI, 1.14-1.85; p = 0.003) and 90 days (OR, 1.37; 95% CI, 1.09-1.73; p = 0.007). Venous thromboembolism was not more frequent in corticosteroid users at 30 days (OR, 2.39; 95% CI, 1.08-5.26; p = 0.031) or 90 days (OR, 1.91; 95% CI, 1.03-3.53; p = 0.039). Revision arthroplasty was more common in corticosteroid users at 12 months (OR, 2.49; 95% CI, 1.35-4.59; p = 0.004), but not 24 months (OR, 2.04; 95% CI, 1.19-3.50; p = 0.010).
  
  
  CONCLUSIONS
  After THA, chronic corticosteroid use is associated with an increased risk of readmission at 30 and 90 days and revision hip arthroplasty at 12 months in corticosteroid users. Patients and providers should discuss these risks before surgery. Insurers should consider incorporating chronic corticosteroid use as a comorbidity in bundled payments for THA, since this patient population is more likely to return to their provider for care during the postoperative period.
  
  
  METHODS
  Level III, therapeutic study.
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Boylan
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Dean C
authors.initials: DC
authors.lastname: Perfetti
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 W Belvedere Avenue, Baltimore, MD, 21215, USA.
authors.forename: Randa K
authors.initials: RK
authors.lastname: Elmallah
authors.affiliation: Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Viktor E
authors.initials: VE
authors.lastname: Krebs
authors.affiliation: Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA.
authors.forename: Carl B
authors.initials: CB
authors.lastname: Paulino
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Reconstruction, Sinai Hospital of Baltimore, 2401 W Belvedere Avenue, Baltimore, MD, 21215, USA. mmont@lifebridgehealth.org.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000139:chemically induced*; D057216:Propensity Score; D011475:Prosthesis Failure; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors; D013923:Thromboembolism / Q000139:chemically induced*
chemical_list: D000305:Adrenal Cortex Hormones