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Lower Extremity Arterial Calcification Predicts Referral to a Closed Unit After Primary Total Hip Arthroplasty
Ezequiel F Martínez1, Agustín M García-Mansilla1, Carlos M Lucero1
1'Sir John Charnley' Hip Surgery Unit, Institute of Orthopaedics 'Carlos E. Ottolenghi', Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Insights
Lower extremity arterial calcification (LEAC) is linked to worse outcomes in total hip arthroplasty (THA) patients, including longer stays and higher mortality. Identifying LEAC preoperatively can improve patient risk stratification.
Area of Science:
- Orthopedic Surgery
- Vascular Medicine
- Geriatric Medicine
Background:
- Lower extremity arterial calcification (LEAC) is a common finding in older adults.
- The association between LEAC and outcomes in primary total hip arthroplasty (THA) patients is not well understood.
- This study investigates the impact of LEAC on postoperative outcomes in THA patients.
Purpose of the Study:
- To determine the association between LEAC and referral to a closed unit (CU), length of stay, 90-day readmissions, and 1-year mortality in primary THA patients.
- To identify LEAC as a risk factor for adverse outcomes following THA.
- To inform preoperative risk stratification for THA patients.
Main Methods:
- Retrospective analysis of 705 primary THA patients.
- LEAC assessed via preoperative antero-posterior pelvic radiograph.
- Outcomes including CU admission, length of stay, 90-day readmissions, and 1-year mortality were recorded.
Main Results:
- Patients with LEAC (9.13%) were older and had more comorbidities.
- LEAC was associated with higher ICU admission (12.5% vs 1.09%), longer hospital stay (4.7 vs 4.2 days), more readmissions (25% vs 5.15%), and higher 1-year mortality (9.3% vs 0%).
- LEAC was a significant risk factor for CU admission (OR=4.77, P=0.034).
Conclusions:
- LEAC is a significant risk factor for adverse outcomes in primary THA patients.
- Presence of LEAC predicts increased risk of ICU admission, prolonged hospitalization, readmissions, and mortality.
- Preoperative identification of LEAC can enhance risk stratification and patient management in THA.
Background:
We aimed to determine the association between lower extremity arterial calcification (LEAC) and referral to a closed unit (CU), length of stay, 90-day readmissions, and 1-year mortality in primary total hip arthroplasty (THA) patients.
Methods:
We retrospectively analyzed 705 patients who underwent primary THA, identifying 64 patients (9.13%) who had LEAC and 641 who did not have LEAC. Patients who had LEAC were older (77 ± 10.0 versus 67 ± 11.5 years; P < 0.001) and had more comorbidities, except for a history of thromboembolic and oncologic diseases (P > 0.05). A preoperative antero-posterior pelvic radiograph was used to assess the presence of LEAC. Admission to CU, length of stay, 90-day readmissions, and 1-year mortality were recorded. A logistic regression model was used to identify risk factors for referral to CU.
Results:
Patients who had LEAC had a higher incidence of admission to the intensive care unit (8 of 64 [12.5%] versus 8 of 641 [1.09%]; P < 0.001), a longer hospital stay (4.7 ± 1.8 versus 4.2 ± 1.3 days; P = 0.006), more readmissions (16 of 64 [25%] versus 33 of 641 [5.15%]; P < 0.001), and a higher 1-year mortality rate (6 of 64 [9.3%] versus 0 of 641 [0%]; P < 0.001) than patients who did not have LEAC. Of the patients who had LEAC admitted to CU, only 3 of 8 had a previous indication to do so in the preoperative assessment performed by the Department of Anesthesiology, while all non-LEAC ones referred to CU did so. Logistic regression analysis showed that LEAC was a risk factor for admission to CU (odds ratio = 4.77; 95% confidence interval: 1.12 to 20.25; P = 0.034).
Conclusions:
The presence of LEAC was a risk factor for transfer to CU, longer in-hospital stays, more readmissions, and a higher 1-year mortality rate. Identifying patients who have LEAC can aid in the preoperative assessment and risk stratification of patients planned for primary THA.
