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The effect of Crohn's disease on outcomes after total hip arthroplasty
Andrew J Hinkle1, Hunter B Jones1, Vikram A Aggarwal2
1Department of Orthopedics, University of Texas Southwestern, Dallas, TX, USA.
Insights
Patients with Crohn's disease (CD) undergoing total hip arthroplasty (THA) experienced longer hospital stays and higher complication rates compared to those without CD. This highlights the need for tailored surgical planning and care for CD patients.
Area of Science:
- Orthopedics
- Gastroenterology
- Health Services Research
Background:
- Crohn's disease (CD) incidence is rising globally, with significant musculoskeletal impacts like arthritis.
- Large joint arthritis is a common manifestation, necessitating interventions like total hip arthroplasty (THA).
Purpose of the Study:
- To compare post-operative length of stay, healthcare costs, and complication rates in patients with and without Crohn's Disease (CD) undergoing THA.
- To identify specific risks and outcomes associated with THA in CD patients.
Main Methods:
- Utilized data from the National Inpatient Sample Database (2016-2019).
- Identified patients with CD and without CD (NCD) undergoing THA using ICD-10 codes.
- Compared length of stay, total cost, and medical/surgical complications between CD and NCD cohorts using SPSS.
Main Results:
- Included 1,171 CD patients and 366,219 NCD patients.
- CD patients were younger, more likely Caucasian, non-obese, and non-emergently admitted.
- CD patients had significantly longer lengths of stay (p < 0.001) and higher risks of acute renal failure, anemia, blood transfusion, pneumonia, DVT, and periprosthetic infection.
- CD patients showed a lower risk of periprosthetic mechanical complications (OR=0.218, p=0.011).
Conclusions:
- CD patients undergoing THA present with younger demographics, extended hospital stays, and increased local and systemic complication rates compared to NCD patients.
- Findings support enhanced surgical candidate selection and operative planning for CD patients.
- Further research into the mechanisms driving these outcome disparities is recommended to advance orthopedic care for CD patients.
Introduction:
Crohn's disease has been increasing in incidence globally and has several musculoskeletal manifestations including large joint arthritis. This study compares post-operative lengths of stay, healthcare costs, and complication rates between patients with and without Crohn's Disease (CD) following Total Hip Arthroplasty (THA).
Methods:
Data were collected from the National Inpatient Sample Database Healthcare Cost and Utilization Project between the years 2016-2019. Patients with Crohn's Disease (CD) and without Crohn's Disease (NCD) undergoing THA were identified using International Classification of Diseases, 10th revision codes (ICD-10-CM/PCS). Length of stay, total cost, and medical and surgical complications were examined during this time period. SPSS (v 27.0 8, IBM Corp. Armonk, NY) was utilized to compare demographic and analytical statistics between CD and NCD patients undergoing THA.
Results:
1,171 (0.32%) CD and 366,219 (99.68%) NCD patients undergoing THA were included. Compared to NCD patients, CD patients were more likely to be Caucasian (p < 0.05), younger (p < 0.001), non-obese (p = 0.022), non-emergently admitted (p = 0.04), and have longer lengths of stay (p < 0.001). Furthermore, CD patients had higher risks of acute renal failure (OR = 1.43, p = 0.025), acute blood loss anemia (OR = 1.431, p < 0.001), blood transfusion (OR = 1.73, p < 0.001), pneumonia (OR = 2.607, p = 0.005), deep vein thrombosis (OR = 2.81, p = 0.035), periprosthetic infection (OR = 1.57, p = 0.05), and length of stay greater than 2 days (OR = 1.293, p < 0.001). However, CD patients had lower risk of periprosthetic mechanical complication (OR = 0.218, p = 0.011).
Conclusion:
This study demonstrates that CD patients undergoing THA are younger, have longer lengths of stay, and have greater rates of both local and systemic complications than NCD patients undergoing THA. As such, this study will aid in surgical candidate selection and proper operative planning for CD patients undergoing THA. Furthermore, future studies investigating the mechanisms behind these differences in post-operative outcomes can help to further advance orthopedic care for CD patients.
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