title: Hematologic Malignancies Are Associated With Adverse Perioperative Outcomes After Total Hip Arthroplasty.
abstract: Advancements in treating hematologic malignancies have improved survival, and these patients may be part of the growing population undergoing total hip arthroplasty (THA). Therefore, the purpose of this study was to evaluate the perioperative outcomes of THA in patients with hematologic malignancies.
  
  
  
  The Nationwide Inpatient Sample identified patients who underwent THA from 2000 to 2011 (n = 2,864,412). Patients diagnosed with any hematologic malignancy (n = 18,012) were further stratified into Hodgkin disease (n = 786), non-Hodgkin lymphoma (n = 5062), plasma cell dyscrasias (n = 2067), leukemia (n = 5644), myeloproliferative neoplasms (n = 3552), and myelodysplastic syndromes (n = 1082). Propensity matching for demographics, hospital characteristics, and comorbidities identified 17,810 patients with any hematologic malignancy and 17,888 controls; additional matching was performed to compare hematologic malignancy subtypes with controls. Multivariate regression was used to analyze surgical and medical complications, length of stay (LOS), and costs.
  
  
  
  Compared to controls, hematologic malignancies increased the risk of any surgery-related complication (odds ratio [OR], 1.4; P < .0001) and any general medical complication (OR, 1.47; P < .0001). Additionally, hematologic malignancies were associated with an increase in LOS (0.16 days; P = .004) and increased costs ($1,101; P < .0001).
  
  
  
  Patients with hematologic malignancies undergoing THA have an increased risk of perioperative complications, longer LOS, and higher costs. The risk quantification for adverse perioperative outcomes in association with increased cost may help to design different risk stratification and reimbursement methods in such populations.
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Newman
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Jaiben
authors.initials: J
authors.lastname: George
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: W Trevor
authors.initials: WT
authors.lastname: North
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: Alison K
authors.initials: AK
authors.lastname: Klika
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Wael K
authors.initials: WK
authors.lastname: Barsoum
authors.affiliation: Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Higuera
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000191:economics; D015897:Comorbidity; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016896:Treatment Outcome
keywords: complications; costs; hematologic malignancies; length of stay; total hip arthroplasty