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Comorbidity, hospital volume may predict THA complications

SooHoo NF. Clin Orthop Relat Res. 2010;468:2363-2371. doi:10.1007/s11999-010-1354-0.

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Patient and provider characteristics influenced the risk of short-term total hip arthroplasty complications, according to prognostic study results.

“These results may be useful for educating patients and anticipating perioperative risks of THA (total hip arthroplasty) in different patient populations,” Nelson F. SooHoo, MD, of the University of California, Los Angeles School of Medicine, and colleagues wrote in their study.

The investigators collected data for all hospitalizations in California from 1995 to 2005 through the Office of Statewide Health Planning and Development (OSHPD). The annually compiled OSHPD database includes all discharge abstracts from all licensed, nonfederal California hospitals. For this study, the investigators reviewed the discharge abstracts for 138,399 patients undergoing primary THA.

SooHoo and colleagues used multiple variable logistic regression models to define how patient and provider characteristics influence complication risks. Patient characteristics included race/ethnicity, age, gender, income, specific comorbidities and modified Charlson comorbidity index. The provider characteristics included hospital volume, rural location and teaching status as independent variables.

The results showed that the 90-day complication rate for primary THA was 3.8%, and the mortality rate was 0.68%. The most common complication was dislocation (1.4%). Being older and having a higher Charlson comorbidity index was associated with a greater short-term complication risk. As a result of increased mortality and infection risks, complicated diabetes was a stronger predictor of an increased aggregate risk of complications within 90 days. Other patient factors linked to an increased complication risk were: rheumatoid arthritis, male gender and black race. Patients treated at low-volume hospitals (below the 60th percentile) had a higher aggregate short-term complication risk compared with patients treated at high-volume hospitals (above the 20th percentile).