Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery

Abstract

Aims Access to joint replacement is being restricted for patients with comorbidities in a number of high-income countries. However, there is little evidence on the impact of comorbidities on outcomes. The purpose of this study was to determine the safety and effectiveness of hip and knee arthroplasty in patients with and without comorbidities. Methods In total, 312,079 hip arthroplasty and 328,753 knee arthroplasty patients were included. A total of 11 common comorbidities were identified in administrative hospital records. Safety risks were measured by assessing length of hospital stay (LOS) and 30-day emergency readmissions and mortality. Effectiveness outcomes were changes in Oxford Hip or Knee Scores (OHS/OKS) (scale from 0 (worst) to 48 (best)) and in health-related quality of life (EQ-5D) (scale from 0 (death) to 1 (full health)) from immediately before, to six months after, surgery. Regression analysis was used to estimate adjusted mean differences (LOS, change in OHS/OKS/EQ-5D) and risk differences (readmissions and mortality). Results Patients with comorbidities had a longer LOS and higher readmission and mortality rates than patients without. In hip arthroplasty patients with heart disease, for example, LOS was 1.20 days (95% confidence interval (CI) 1.15 to 1.25) longer and readmission rate was 1.52% (95% CI 1.34% to 1.71%) and mortality 0.19% (95% CI 0.15% to 0.23%) higher. Similar patterns were observed for knee arthroplasty patients. Patients without comorbidities reported large improvements in function (mean improvement OHS 21.3 (SD 9.91) and OKS 15.9 (SD 10.0)). Patients with comorbidities reported only slightly smaller improvements. In patients with heart disease, mean improvement in OHS was 0.39 (95% CI 0.27 to 0.51) and in OKS 0.56 (95% CI 0.45 to 0.67) less than in patients without comorbidities. There were no significant differences in EQ-5D improvement. Conclusion Comorbidities were associated with small increases in adverse safety risks but they have little impact on pain or function in patients undergoing hip or knee arthroplasty. These results do not support restricting access to hip and knee arthroplasty for patients with common comorbidities. Cite this article: Bone Joint J 2021;103-B(1):56–64.

10-year evolution of day-case hip and knee arthroplasty: a Danish nationwide register study of 166,833 procedures from 2010 to 2020

“…Comparison of readmission rates in each arthroplasty group between the time periods 2010–2013, 2014–2017, and 2018–2020 was done using logistic regression adjusted for age, sex, and CCI score. Adjusting variables were chosen based on previous studies associating these patient characteristics with increased risk of readmission ( 15 ). A similar but unadjusted analysis for mortality risk was conducted, due to the rare occurrence of mortality.…”

Primary knee arthroplasty for osteoarthritis restores patients’ health-related quality of life to normal population levels

“…However, HRQoL has not been shown to vary in patients with or without comorbidities following primary KA. 51…”

Emergency department visits following total joint arthroplasty: do revisions present a higher burden?

“…In addition to the unique technical challenges and increased complexity of rTJA, more medical comorbidities suggest that patients undergoing rTJA may be at higher risk of 90-day ED visits. 30 , 31 Whether or not some of these ED visits are preventable by way of increased accessibility of the surgical team and patient communication is a topic worth further investigation.…”