Fibromyalgia as a Risk Factor for Postoperative Complications Following Total Knee Arthroplasty

Area of Science:

• Orthopedic Surgery
• Rheumatology
• Health Services Research

Background:

• Fibromyalgia is a chronic condition causing widespread pain, fatigue, and sleep disturbances.
• Its impact on outcomes following total knee arthroplasty (TKA) requires further investigation.
• Prior studies noted increased complications in TKA patients with fibromyalgia but didn't control for confounding factors like opioid use.

Purpose of the Study:

• To evaluate the association between fibromyalgia and postoperative complications after primary total knee arthroplasty (TKA).
• To compare complication rates between fibromyalgia patients and a matched control group, controlling for key risk factors.
• To determine if fibromyalgia independently increases the risk of adverse outcomes post-TKA.

Main Methods:

• A retrospective cohort study utilized the National Inpatient Sample (NIS) database from 2016-2021.
• Patients undergoing unilateral, primary TKA were identified, with fibromyalgia status as the primary exposure.
• A 1:1 matching strategy was employed to control for age, sex, race, ethnicity, insurance, comorbidities, smoking, and opioid use.

Main Results:

• The study included 96,870 patients (48,435 with fibromyalgia).
• Fibromyalgia was associated with significantly higher rates of hypotension, anemia, atelectasis, urinary retention, fluid/electrolyte imbalance, intestinal obstruction, constipation, and delirium.
• A greater proportion of fibromyalgia patients (18.1%) were not discharged directly home compared to controls (15.4%).

Conclusions:

• Fibromyalgia is independently associated with an increased risk of multiple postoperative complications after primary TKA.
• These findings underscore the importance of considering fibromyalgia as a risk factor in TKA patient management.
• Further research should explore targeted interventions to mitigate these elevated risks in fibromyalgia patients undergoing TKA.