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Comorbidities increase post-arthroplasty complication rates

Patients with both obesity and diabetes had a 75% higher risk for nonroutine hospital discharge.

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Patients with diabetes, hypertension or obesity have higher complications rates following joint replacement surgery, according to a new study published in Clinical Orthopaedics and Related Research.

Laurence D. Higgins, MD, and colleagues at Duke University Medical Center, Durham, N.C., and at other institutions in the United States and in Switzerland, conducted the study. Using the Nationwide Inpatient Samples (NIS) database — a publicly available database supported by the U.S. Agency for Healthcare Research and Quality that contains information on more than 8 million patients — the researchers identified 959,839 patients who underwent knee, hip or shoulder arthroplasty between 1988 and 2000. These patients had a mean age of 70.8 years. Most patients, 64%, were white and 64.6% were female, according to a press release.

The researchers found that 3.7% of obese patients, 2.8% of hypertensive patients and 2.9% of diabetic patients experienced in-hospital complications. Comparatively, 2.6% of normal patients experienced such complications.

Additionally, the likelihood of experiencing a nonroutine hospital discharge was 30% higher for diabetic patients and 45% higher for obese patients. Further, patients with both obesity and diabetes had a 75% higher risk compared to normal patients.

“The analysis identified a subset of patients who are at increased risk for worse outcomes,” Higgins, senior author of the study, said in the press release. “Our study demonstrates the need for clinical protocols and guidelines specifically aimed at patients with these comorbidities, as well as the need for adequate assessment of the risks and benefits of joint replacement procedures in these patients,” he continued.

Strategies such as better control of blood glucose levels and blood pressure during surgery must be evaluated to improve postoperative outcomes, the authors said. Postoperative use of blood-thinning drugs should also be investigated for helping to prevent deep vein thrombosis, they noted.

Duke University’s Center for Excellence in Surgical Outcomes supported the study.

For more information:

• Jain NB, Ultich G, Pietrobon R, et. al. Comorbidities increase complication rates in patients having arthroplasty. Clin Orthop. 2005;435:232-238.