Total Hip Arthroplasty: COPD and its Effect on Postoperative Complications

Abstract

Introduction The demand for Total Hip Arthroplasty (THA) has rapidly risen and continues to due to high success rates of this procedure and the growing aging population. Particularly in Chronic Obstructive Pulmonary Disease (COPD), studies have indicated an increased risk of various postoperative complications across several surgery types. Despite the prevalence of COPD, very little has been investigated regarding postsurgical complications in patients with COPD following a THA. The aim of the current study is to utilize the NSQIP database and determine differences in short-term postoperative complications after undergoing THA, comparing patients with and without COPD. Methods In total, 74,814 patients were included in the analysis looking at how COPD contributes to the rates of postoperative complications in primary THA. Data was obtained from the National Surgical Quality Improvement Project Database years 2005-2014, with readmission/reoperation data beginning in 2011. THA cases were selected out of the database using current procedural terminology (CPT) code 27130. On univariate analysis, p-values were calculated using chi-square for categorical variables and one-way ANOVA for continuous variables. On multivariate analysis, logistic regression was used to control for preoperative comorbidities and calculate p-values. Results On multivariate analysis and after controlling for contributing comorbidities, having COPD was found to be an independent predictor of superficial surgical site infection (OR: 1.74), pneumonia (OR: 3.69), reintubation (OR: 2.65) failure to wean (OR: 3.45), urinary tract infection (OR: 1.46), needing a postoperative transfusion (OR: 1.19), and sepsis (OR: 1.97). COPD also independently predicted whether a patient would be discharged home or not (OR: 1.50). Discussion Although COPD has been linked to negative postoperative outcomes across several surgeries, few studies have examined postsurgical complications in patients with COPD following a THA. Our study found patients with COPD to have higher rates of superficial surgical site infection, pneumonia, reintubation, failure to wean, urinary tract infection, needing a postoperative transfusion, and sepsis. COPD also independently predicted whether a patient would be discharged home or not. Managing high-risk surgical patients requires a better understanding of possible complications a patient faces and enhancing perioperative conditions to improve outcomes. Given our study identified certain complications as independent risk factors for patients with COPD, surgeons and other healthcare providers can use this information to more accurately counsel patients and make perioperative adjustments accordingly

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