Inter-atrial wall abnormality is associated with adverse same-admission outcomes following total hip arthroplasty

Total hip arthroplasty (THA) is the second most common joint arthroplasty procedure and is the definitive treatment for severe hip osteoarthritis. Individuals with inter-atrial wall abnormalities (IAWAs), such as atrial septal defect (ASD) or patent foramen ovale (PFO), may be at an increased baseline risk for thromboembolic complications. The purpose of this study was to elucidate the association between patients with IAWAs and perioperative outcomes of THA.

We performed a retrospective cohort study utilizing the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS) database. Admissions for THA between 2010 and 2021 were identified using the International Classification of Disease-9 (ICD-9) and ICD-10 procedure codes. Patients were assigned to the IAWA cohort, the primary exposure, based on ICD-9-CM and ICD-10-CM diagnosis codes. Each patient with an IAWA was propensity-score matched to twenty patients without an IAWA. The primary outcomes studied were procedure-related complications and admission mortality.

Compared to patients in the non-IAWA cohort, those in the IAWA cohort had 1.46 times higher (95% CI 1.14 to 1.86; p = 0.002) odds for same-admission procedure-related complications following THA. Within procedure-related complications, IAWA was also associated with 14.18 times higher (95% CI 9.84 to 20.34; p < 0.001) odds of thromboembolic complications, which included ischemic stroke, pulmonary embolism (PE), and deep vein thrombosis (DVT).

Compared to patients without IAWAs, those with IAWAs who underwent THA had higher odds for same-admission procedure-related complications, including thromboembolic complications, but not same-admission mortality. Further research on perioperative THA management in patients with IAWAs is needed.

Level III: Retrospective Cohort Study.