title: Incidence of and Preoperative Risk Factors for Surgical Delay in Primary Total Hip Arthroplasty: Analysis From the American College of Surgeons National Surgical Quality Improvement Program.
abstract: Total joint arthroplasty is a proven treatment for osteoarthritis of the knee and hip that has failed conservative treatment. While most of total joint arthroplasty is considered elective with surgery on the day of admission, a small subset of patients may require delay in surgery past the day of admission. Recently, surgical delay for primary total knee arthroplasty has been identified. However, the incidence, outcomes, and risk factors for delay in surgery before total hip arthroplasty (THA) have not been previously defined.
  
  
  
  In patients undergoing THA, we sought to define (1) the incidence of and risk factors for delay in surgery, (2) the postoperative complications between surgical delay and no surgical delay cohorts, and (3) association of the Charlson comorbidity index (CCI) in patients with delay of surgery.
  
  
  
  We retrospectively queried the National Surgical Quality Improvement Program database using Current Procedural Terminology billing codes and identified 7890 THAs performed between 2006 and 2010. Univariate and subsequent multivariate logistic regression analysis were then used to identify risk factors for surgical delay. Correlation between CCI and surgical delay in THA was evaluated.
  
  
  
  One-hundred seventy-nine patients (2.31%) were identified as experiencing a surgical delay before THA. Multivariate analysis identified congestive heart failure (CHF) (P = .0038), bleeding disorder (P < .0001), sepsis (P < .0001), prior operation in past 30 days (P = .0001), dependent functional status (P < .0001), American Society of Anesthesiologists class 3 (P = .0001), American Society of Anesthesiologists class 4 (P = .0023), significant weight loss (P = .0109), and hematocrit <38% (P < .0001) as independent risk factors for delay in surgery. Compared with the nondelay cohort, those experiencing surgical delay before THA had higher rates of postoperative surgical (8.9% vs 3.1%, P < .0001) and medical complications (23.5% vs 10.1%, P < .0001). Mean CCI was higher in the THA surgical delay cohort (3.16 vs 2.24, P < .0001) compared with the nondelay group.
  
  
  
  Surgical delay in patients undergoing THA may cause undue disruption in surgeon and hospital resource utilization. In an era of quality assessment and cost consciousness, it is important to understand that the short-term outcomes of elective, same day THA differ dramatically from those hospitalized for medical necessity before surgery. Surgeons should consider thorough medical evaluation in those with CHF, bleeding disorders, sepsis, significant weight loss, and hematocrit <38% before hospital admission.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Lowa; Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
authors.forename: Ong-Art
authors.initials: OA
authors.lastname: Phruetthiphat
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Lowa.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Lowa.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Anthony
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Lowa.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Pugely
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Lowa.
authors.forename: Lucian C
authors.initials: LC
authors.lastname: Warth
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Iowa Hospital and Clinics, Iowa City, Lowa.
authors.forename: John J
authors.initials: JJ
authors.lastname: Callaghan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data*; D015897:Comorbidity; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010003:Osteoarthritis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology*; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: ACS-NSQIP; incidence; primary total hip arthroplasty; risk factors; surgical delay