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Published on: September 7, 2022
Hypothyroidism Impacts Clinical and Healthcare Utilization Outcomes After Primary Total Hip Arthroplasty
Sumanth R Chandrupatla1, Kranti C Rumalla2, Jasvinder A Singh3
1Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama.
Insights
Hypothyroidism is linked to worse outcomes after total hip arthroplasty (THA), including longer hospital stays and more complications. Further research is needed to develop targeted interventions for these patients.
Area of Science:
- Orthopedic Surgery
- Endocrinology
- Health Services Research
Background:
- Hypothyroidism is a common endocrine disorder.
- Its impact on primary total hip arthroplasty (THA) outcomes requires comprehensive assessment.
- Understanding these associations can guide peri-operative care.
Purpose of the Study:
- To evaluate the association between hypothyroidism and outcomes following primary THA.
- To stratify these outcomes based on the underlying diagnosis leading to THA.
Main Methods:
- A national database (2016-2020) was used to identify 2,467,215 primary THA patients.
- Patients were stratified by diagnosis: osteoarthritis, osteonecrosis, traumatic fracture, inflammatory arthritis, and other.
- Multivariable-adjusted regression analyses were performed, controlling for numerous demographic and clinical factors.
Main Results:
- Hypothyroidism was associated with increased length of stay, total charges, non-routine discharges, blood transfusions, and prosthetic fractures overall.
- Specific associations were observed within diagnostic subgroups, including osteoarthritis, osteonecrosis, and traumatic fracture cohorts.
Conclusions:
- Hypothyroidism is significantly associated with adverse outcomes and increased healthcare utilization in THA patients.
- Developing and testing targeted interventions for hypothyroidism is crucial to improve THA peri-operative results.
Background:
Our objective was to assess the association of hypothyroidism with outcomes of primary total hip arthroplasty (THA) overall and stratified by underlying diagnosis.
Methods:
We identified patients undergoing primary THA in a national database from 2016 to 2020. We stratified them based on primary diagnoses into hip osteoarthritis (OA; N = 1,761,960), osteonecrosis (ON; N = 78,275), traumatic fracture (N = 532,910), inflammatory arthritis (IA; N = 3,520), and "other" (N = 90,550). We identified hypothyroidism and complications using secondary diagnoses. Among 2,467,215 patients undergoing primary THA, mean age was 68 years (range, 18 to 90), and 58.3% were women. Complications codes only included initial encounters. We performed time-trends analyses and multivariable-adjusted regression analyses adjusted for demographics, expected primary payer, a comorbidity score, elective versus non-elective admission, and hospital characteristic information, with clinical and healthcare utilization outcome as endpoints.
Results:
Overall, hypothyroidism was significantly associated with increased LOS, total charges, non-routine discharges, blood transfusions, and prosthetic fractures. In the OA cohort, hypothyroidism was associated with increased LOS, total charges, and non-routine discharges (P < .001 for each), and blood transfusions (P = .02). Hypothyroidism was associated with increased total charges (P = .001) in the ON cohort and with increased LOS, non-routine discharge, and blood transfusion (P < .05 each) in the traumatic fracture cohort.
Conclusions:
Hypothyroidism was associated with blood transfusions, prosthetic fractures, and utilization outcomes in THA patients. Tailored intervention strategies for hypothyroidism should be tested for their efficacy to improve THA peri-operative outcomes.
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