Coagulopathies Are a Risk Factor for Adverse Events Following Total Hip and Total Knee Arthroplasty

Current literature suggests a correlation between preoperative coagulopathies and postsurgical adverse events (AEs). However, this correlation has not been specifically assessed in the total hip arthroplasty (THA) and the total knee arthroplasty (TKA) populations. Patients who underwent primary THA and TKA with coagulopathy data were identified from the 2011-2015 American College of Surgeons National Surgical Quality Improvement Program database. Coagulopathies studied were low platelets, high partial thromboplastin time (PTT), high international normalized ratio (INR), and other hematological conditions. Univariate and multivariate analyses were conducted to explore the relationship between coagulopathies and 30-day AEs following surgery in these populations. In total, 39,605 THA patients and 67,685 TKA patients were identified. Of these, approximately 16% had a coagulopathy. These patients tended to be older and have a dependent functional status, American Society of Anesthesiologists score of 3 or greater, and diabetes mellitus. In the THA cohort, low platelets, high PTT, high INR, and other hematological conditions were associated with increased odds of any AE, major AEs, and minor AEs. High INR and other hematological conditions were associated with an increased odds of hospital readmission. In the TKA group, low platelets, high INR, and other hematological conditions were associated with increased odds of any AE, major AEs, and minor AEs. High PTT was associated with increased odds of major AEs and readmissions. Presence of a coagulopathy was associated with multiple AEs following both THA and TKA. This shows that special attention should be paid patients with any form of coagulopathy to minimize the potential risk of AEs. [Orthopedics. 2020;43(4):233-238.].