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Primary total hip arthroplasty complications and costs in liver transplant recipients: a matched analysis using a
Scott J Douglas1, Ethan A Remily1, Oliver C Sax1
1Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, MD, USA.
Insights
Liver transplant recipients (LTR) undergoing total hip arthroplasty (THA) experienced longer hospital stays but showed no increased risks or costs compared to the general population. These findings indicate THA is safe for LTR patients.
Area of Science:
- Orthopedic Surgery
- Transplant Surgery
- Health Services Research
Background:
- The global increase in liver transplant recipients (LTR) necessitates understanding their outcomes after total hip arthroplasty (THA).
- Potential increased risks and comorbidities in LTR may impact THA outcomes and healthcare costs.
- Comparative analysis of THA in LTR versus the general population is crucial.
Purpose of the Study:
- To compare the outcomes and costs of total hip arthroplasty (THA) between liver transplant recipients (LTR) and a matched general population.
- To evaluate length of stay, readmission rates, complication rates, and total cost of care for THA in LTR.
Main Methods:
- Utilized a large national database (Medicare, Medicaid, private insurance claims) from 2010-2019.
- Identified primary THAs and matched 513 LTR with 10,759 non-transplant controls (1:20 ratio).
- Matching criteria included age, sex, Charlson Comorbidity Index, obesity, and diabetes status.
Main Results:
- LTR had a significantly longer average length of stay (4.2 vs. 3.4 days, p < 0.001).
- No significant differences were observed in 30-day readmissions (5.7% vs. 4.1%) or 90-day dislocation rates (2.9% vs. 2.4%).
- Total 90-day costs of care were comparable between LTR and control groups (p = 0.756).
Conclusions:
- Total hip arthroplasty in liver transplant recipients is associated with longer hospital stays but not increased short-term complications or costs.
- These findings suggest that LTR can safely undergo THA without major concerns regarding adverse events or financial burden.
- Further research could explore long-term outcomes and specific management strategies for LTR undergoing THA.
Background:
The number of liver transplant recipients (LTR) is worldwide increasing and, as the survival is improving as well, there is an increasing number of patients needing total hip arthroplasty (THA). There might be increased risks for this specific group of patients and due to their comorbidities costs might be higher too. Using a big national database outcome and cost of THA should be compared between liver transplant recipients and the general population.
Methods:
The study was performed using a collection of Medicare, Medicaid, and private insurance claims. Length of stay (LOS), 30-day readmissions, complications rates up to 5 years, and 90-day total cost of care between liver transplant recipients and matched non-transplant patients should be compared. All primary THAs from 2010 to 2019 were identified. 513 patients with a liver transplant before their THA were matched to 10,759 patients without a history of solid organ transplant at a 1:20 ratio based on age, sex, Charlson Comorbidity Index, obesity, and diabetes status.
Results:
LTR had a longer average LOS (4.2 vs. 3.4 days, p < 0.001). There was no difference in the thirty-day readmissions (5.7% vs. 4.1%, p = 0.117) and 90-day dislocation rates (2.9% vs. 2.4%, p = 0.600). Total costs in the first ninety days after THA were not different between the LTR and controls (p = 0.756).
Conclusions:
These findings suggest that complications and costs are no major point of concern in patients with liver transplant that are operated with THA.
