Inhospital Complications of Patients With Neuromuscular Disorders Undergoing Total Joint Arthroplasty

Abstract

Introduction: Orthopaedic surgeons are wary of patients with neuromuscular (NM) diseases as a result of perceived poor outcomes and lack of data regarding complication risks. We determined the prevalence of patients with NM disease undergoing total joint arthroplasty (TJA) and characterized its relationship with in-hospital complications, prolonged length of stay, and total charges. Methods: Data from the Nationwide Inpatient Sample from 2005 to 2014 was used for this retrospective cohort study to identify 8,028,435 discharges with total joint arthroplasty. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify 91,420 patients who had discharge diagnoses for any of the NM disorders of interest: Parkinson disease, multiple sclerosis, cerebral palsy, cerebrovascular disease resulting in lower extremity paralysis, myotonic dystrophy, myasthenia gravis, myositis (dermatomyositis, polymyositis, and inclusion-body myositis), spinal muscular atrophy type III, poliomyelitis, spinal cord injury, and amyotrophic lateral sclerosis. Logistic regression was used to estimate the association between NM disease and perioperative outcomes, including inpatient adverse events, length of stay, mortality, and hospital charges adjusted for demographic, hospital, and clinical characteristics. Results: NM patients undergoing TJA had increased odds of total surgical complications (odds ratio [OR] = 1.21; 95% confidence interval [CI], 1.17 to 1.25; P < 0.0001), medical complications (OR = 1.41; 95% CI, 1.36 to 1.46; P < 0.0001), and overall complications (OR = 1.32; 95% CI, 1.28 to 1.36; P < 0.0001) compared with non-NM patients. Specifically, NM patients had increased odds of prosthetic complications (OR = 1.09; 95% CI, 0.84 to 1.42; P = 0.003), wound dehiscence (OR = 5.00; 95% CI, 1.57 to 15.94; P = 0.0002), acute postoperative anemia (OR = 1.20; 95% CI, 1.16 to 1.24; P < 0.0001), altered mental status (OR = 2.59; 95% CI, 2.24 to 2.99; P < 0.0001), urinary tract infection (OR = 1.45; 95% CI, 1.34 to 1.56; P < 0.0001), and deep vein thrombosis (OR = 1.27; 95% CI, 1.02 to 1.58; P = 0.021). No difference of in-hospital mortality was observed (P = 0.155). Discussion: Because more patients with NM disease become candidates of TJA, a team of neurologists, anesthesiologists, therapists, and orthopaedic surgeon is required to anticipate, prevent, and manage potential complications identified in this study. Level of Evidence: Level III, retrospective cohort study

Increased rate of complications in myasthenia gravis patients following hip and knee arthroplasty: a nationwide database study in the PearlDiver Database on 257,707 patients

“…Because the majority of patients undergoing total joint replacement are adults, low rates of malignant hyperthermia in this population are expected. The increased occurrence of systemic complications in patients with MG aligns partially with the results of previous studies (Chang et al 2017, Cichos et al 2019. Similar to the findings by Chang et al (2017), MG patients experienced higher rates of postoperative pneumonia and sepsis (Chang et al 2017).…”

“…Similar to the findings by Chang et al (2017), MG patients experienced higher rates of postoperative pneumonia and sepsis (Chang et al 2017). Furthermore, these findings also support those by Cichos et al (2019), which demonstrated higher rates of postoperative anemia and deep vein thrombosis in patients with MG (Cichos et al 2019). Our study further expands the scope of systemic complications demonstrating MG patients are at a higher risk by also showing higher rates of cerebrovascular events, respiratory failure, acute MI, and acute renal failure.…”

“…Our study further expands the scope of systemic complications demonstrating MG patients are at a higher risk by also showing higher rates of cerebrovascular events, respiratory failure, acute MI, and acute renal failure. Chang et al (2017) limited their examination of complications to 30 days post-discharge, and Cichos et al (2019) limited their data collection to the perioperative event. Our data documented the increased occurrence of these complications during the hospital stay and within the 90-day post-discharge period.…”

“…Thymectomy improves clinical outcomes, reduces the need for immunosuppressive therapy, and may be curative in a subset of patients (Wolfe et al 2016, Remes-Troche et al 2002. Advancements in the treatment have improved life expectancy and increased the demand for arthroplasty in these patient (Carr et al 2010, Cichos et al 2019. As the demand for primary hip and knee arthroplasty is projected to increase (Sloan et al 2018), it is imperative that surgeons have access to data outlining clinical outcomes following arthroplasty in MG patients.…”

“…However, there remains a lack of research specifically aimed at identifying the risks and complications seen with arthroplasties in patients with MG. Prior studies examining postoperative complications in patients with MG have demonstrated increased risks of adverse medical events including re-intubation (Cichos et al 2019), increased surgical site bleeding, myasthenic crisis, pneumonia, and septicemia (Marulli et al 2013).…”