The Impact of Solid Organ Transplant History on Inpatient Complications, Mortality, Length of Stay, and Cost for Primary Total Hip Arthroplasty Admissions in the United States

Abstract

Background As the prevalence of and life expectancy after solid organ transplantation increases, some of these patients will require total hip arthroplasty (THA). Immunosuppressive therapy, metabolic disorders, and post-transplant medications may place transplant patients at higher risk of adverse events following surgery. The objective of this study was to compare inpatient complications, mortality, length of stay (LOS), and costs for THA patients with and without solid organ transplant history. Methods A retrospective cross-sectional analysis was conducted using 1998-2011 Nationwide Inpatient Sample. Primary THA patients were queried (n=3,175,456). After exclusions, remaining patients were assigned to transplant (n=7,558) or non-transplant groups (n=2,772,943). After propensity score matching, adjusted for patient and hospital characteristics, logistic regression and paired t-tests examined the effect of transplant history on outcomes. Results Between 1998 and 2011, THA volume among transplant patients grew approximately 48%. The overall prevalence of one or more complications following THA was greater in the transplant group than in the non-transplant group (32.0% vs. 22.1%; p<0.001). In-hospital mortality was minimal, with comparable rates (0.1%) in both groups (p=0.93). Unadjusted trends show that transplant patients have greater annual and overall mean LOS (4.47 days) and mean admission costs ($18,402) than non-transplant patients (3.73 days; $16,899; p<0.001). After propensity score matching, transplant history was associated with increased complication risk (odds ratio, 1.56;) after THA, longer hospital LOS (+0.64 days; p<0.001), and increased admission costs (+$887; p=0.005). Conclusions Transplant patients exhibited increased odds of inpatient complications, longer LOS, and greater admission costs after THA compared with non-transplant patients.

A retrospective matched cohort single‐center study evaluating outcomes of COVID‐19 and the impact of immunomodulation on COVID‐19‐related cytokine release syndrome in solid organ transplant recipients

“…SOT patients also had longer length of hospital stay. One possible explanation is the higher degree of medical care provided to SOT patients as seen in other non–COVID‐related hospitalizations 22,23 . Another possibility is that the SOT patients in our study had a higher proportion of critical disease and ICU needs (although not found statistically significant).…”

Clinical Outcomes following Primary Hip Replacement Arthroplasties in Patients with Solid Organ Transplantation: A Systematic Review and Meta-Analysis

“…Of these, articles were excluded after screening their titles, abstracts, and full-text reviews. Thus, 10 articles 5 13 14 15 16 17 18 19 20 21) were eligible for qualitative and quantitative data syntheses. Regarding study selection, the agreement between the two reviewers was almost perfect at the title review and abstract review stages (κ=0.814 and κ=0.849, respectively) as well as the full-text review stage (κ=1.0).…”

What’s New in Hip Replacement

“…An increased risk of perioperative complications, longer length of stay, and higher admission cost following THA were associated with a patient history of solid organ transplant and hematologic malignancies 33,34 .…”