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Complications Are Elevated in Patients Who Have Decubitus Ulcers Undergoing Hemiarthroplasty, but There Are No
Jeffrey Y Wang1, Andrew B Harris2, Jessica Schmerler2
1Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Background:
Patients undergoing hemiarthroplasty for femoral neck fracture are generally frail and prone to complications. Decubitus ulcers, associated with poor mobility, may indicate worse outcomes, though this relationship remains understudied. We hypothesized that preoperative decubitus ulcers increase the risk of postoperative complications at 90 days and two years following hemiarthroplasty.
Methods:
A national administrative claims database was queried for patients undergoing hemiarthroplasty for femoral neck fracture from 2010 to 2021. Patients were stratified by the presence of absence of a preoperative decubitus ulcer. Multivariable logistic regressions were used to evaluate the association between preoperative decubitus ulcers and postoperative complications occurring within 90 days and two years, including revision surgery, periprosthetic joint infection, and periprosthetic fracture. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at P < 0.05. A total of 76,539 patients were included, of whom 1,288 (1.7%) had a diagnosed decubitus ulcer prior to surgery. The mean age was 72 years (range, 50 to 89).
Results:
Within the first 90 days postoperatively, patients who had decubitus ulcers had an increased risk of 90-day readmission (OR: 1.4, 95% CI: 1.2 to 1.6), surgical site infection (OR: 1.6, 95% CI: 1.2 to 2.2), pneumonia (OR: 2.2, 95% CI: 1.8 to 2.6), sepsis (OR: 3.2, 95% CI: 2.5 to 4.0), and deep vein thrombosis (OR: 1.8, 95% CI: 1.4 to 2.3). There was no statistically significant difference in 90-day renal failure, arrhythmia, or mortality. The 2-year risks of revision surgery (OR: 1.4, 95% CI: 0.9 to 2.1), periprosthetic joint infection (OR: 1.5, 95% CI: 0.7 to 2.6), and periprosthetic fracture (OR: 1.5, 95% CI: 0.8 to 2.8) were also not significantly different.
Conclusions:
Preoperative decubitus ulcers are associated with elevated risk of multiple 90-day postoperative complications but do not predict increased 2-year surgical complication rates.
