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Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study
Gwyneth C Maloy1, Alexander J Kammien1, Lee E Rubin1
1Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut.
Background:
Many previous studies of total hip arthroplasty (THA) have focused on adverse events occurring within 30 days of surgery. Studies examining 90-day postoperative adverse events have typically not focused on the timing of adverse events within that period. The current study evaluated the rate and timing of adverse events within 90 days of THA.
Methods:
Adult THA patients between 2010 and 2020 Q3 were identified from a large administrative dataset. Rates and timing of 90-day adverse events were determined. The median, interquartile range, and middle 80% were calculated based on the time of diagnosis for each adverse event. These were also dichotomized as occurring before or after 30 days and predictive factors for later adverse events were determined.
Results:
Overall, 81,158 adverse events were noted, of which 56,500 (69.0%) were diagnosed within 30 days of surgery and 25,355 (31.0%) were diagnosed 31-90 days after surgery. The proportion of adverse events occurring 31-90 days after surgery ranged from 6% (transfusion) to 45% (wound dehiscence). Patients experiencing a later adverse event were more likely to be women and to have higher Elixhauser Comorbidity Index (ECI) scores.
Conclusion:
Almost one-third of adverse events following THA were diagnosed between postoperative days 31 and 90, highlighting the importance of looking beyond 30 days when estimating patients' risk of postoperative adverse events. These data may inform future research, patient counseling, and prevention strategies.
