title: The Impact of Solid Organ Transplant History on Inpatient Complications, Mortality, Length of Stay, and Cost for Primary Total Hip Arthroplasty Admissions in the United States.
abstract: As the prevalence of and life expectancy after solid organ transplantation increases, some of these patients will require total hip arthroplasty (THA). Immunosuppressive therapy, metabolic disorders, and post-transplant medications may place transplant patients at higher risk of adverse events following surgery. The objective of this study was to compare inpatient complications, mortality, length of stay (LOS), and costs for THA patients with and without solid organ transplant history.
  
  
  
  A retrospective cross-sectional analysis was conducted using 1998-2011 Nationwide Inpatient Sample. Primary THA patients were queried (n = 3,175,456). After exclusions, remaining patients were assigned to transplant (n = 7558) or non-transplant groups (n = 2,772,943). After propensity score matching, adjusted for patient and hospital characteristics, logistic regression and paired t-tests examined the effect of transplant history on outcomes.
  
  
  
  Between 1998 and 2011, THA volume among transplant patients grew approximately 48%. The overall prevalence of one or more complications following THA was greater in the transplant group than in the non-transplant group (32.0% vs 22.1%; P < .001). In-hospital mortality was minimal, with comparable rates (0.1%) in both groups (P = .93). Unadjusted trends show that transplant patients have greater annual and overall mean LOS (4.47 days) and mean admission costs ($18,402) than non-transplant patients (3.73 days; $16,899; P < .001). After propensity score matching, transplant history was associated with increased complication risk (odds ratio, 1.56) after THA, longer hospital LOS (+0.64 days; P < .001), and increased admission costs (+$887; P = .005).
  
  
  
  Transplant patients exhibited increased odds of inpatient complications, longer LOS, and greater admission costs after THA compared with non-transplant patients.
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Suparna M
authors.initials: SM
authors.lastname: Navale
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Caleb R
authors.initials: CR
authors.lastname: Szubski
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Pratik P
authors.initials: PP
authors.lastname: Desai
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D003365:Costs and Cost Analysis / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D010343:Patient Admission / Q000191:economics; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Nationwide Inpatient Sample; complication; length of stay; solid organ transplant; total hip arthroplasty