Hematologic Malignancies Are Associated With Adverse Perioperative Outcomes After Total Hip Arthroplasty.
Newman JM, George J, North WT, Navale SM, Klika AK, Barsoum WK, and Higuera CA. Hematologic malignancies are associated with adverse perioperative outcomes after total hip arthroplasty. J Arthroplasty 2017; 32(8):2436-2443
The Journal of arthroplasty
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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).
CONCLUSION: 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.
Medical Subject Headings
Adult; Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip; Comorbidity; Female; Hematologic Neoplasms; Hospitals; Humans; Length of Stay; Male; Middle Aged; Odds Ratio; Postoperative Complications; Treatment Outcome