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Study links dementia with increased mortality and obesity with infection after THA

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Kevin J. Bozic

Risk factors such as psychoses, renal disease and dementia were found to be associated with an increased postoperative mortality risk among Medicare patients who underwent total hip arthroplasty (THA). Obesity, preoperative anemia and diabetes are other risk factors also associated with an increase of periprosthetic joint infection, according to a recently presented study.

Kevin J. Bozic, MD, MBA, presented his team’s findings at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons.

Bozic noted that risk factors such as psychoses, renal disease and dementia were also found in his team’s study to be associated with an increased postoperative mortality risk among Medicare patients who underwent total hip arthroplasty (THA).

“Despite a number of classification systems available to stratify patients by risk preoperatively … none have been validated for hip and knee arthroplasty patients, and therefore patient-specific risk factors in the elderly population are poorly understood,” Bozic said. “The purpose of this study was to identify baseline patient co-morbidities associated with an increased risk of [PJI] and postoperative mortality in Medicare patients.”

To calculate the relative risk of PJI and mortality as baseline medical co-morbidities, Bozic and his team used the Medicare 5% sample and reviewed 40,919 primary THAs performed between 1998 and 2007. Cox regression was used to gauge the impact of 30 co-morbidities on mortality and PJI. Controls were put in place for age, gender, race, census region, public assistance and other baseline co-morbidities.

Bozic’s team found rheumatologic disease, obesity, coagulopathy, preoperative anemia, diabetes and cardiac arrhythmia to be the most significant independent PJI risk factors. Bozic noted that congestive heart failure, metastatic cancer, psychoses, renal disease and dementia were “most significant risk factors for 90-day postoperative mortality.”

“The importance here is that both psychoses and dementia were identified as risk factors for mortality, and this is important,” Bozic said. “Consider the mental health — and the stability of mental health — in your patients before considering elective surgery.”

Reference:

• Bozic KJ, Lau E, Ong K, et al. Risk factors for PJI & Postoperative Mortality following THA in Medicare patients. Paper #480. Presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons. Feb. 14-19. San Diego.
• Disclosure: Bozic has no relevant financial disclosures.

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