Introduction
Patients and Methods
Characteristic | Description of sample |
---|---|
Number of patients | 138,399 |
Mean age (standard deviation) | 66 years (+/− 13 yrs.) |
Gender | |
1) Male | 1) 79,514 (57%) |
2) Female | 2) 58,885 (43%) |
Race/Ethnicity | |
1) White | 1) 117,107 (85%) |
2) Black | 2) 6,051 (4%) |
3) Hispanic | 3) 9,368 (7%) |
4) Asian/Pacific Islander | 4) 3,006 (2%) |
5) Other | 5) 2,867 (2%) |
Income < 20th percentile | 5,840 (4%) |
Complicated diabetes | 743 (< 1%) |
Peripheral vascular disease | 2,179 (2%) |
Rheumatoid arthritis | 5,565 (4%) |
Hospital volume | |
1) High | 1) 27,480 (20%) |
2) Intermediate | 2) 56,431 (41%) |
3) Low | 3) 54,488 (39%) |
Teaching status | 18,455 (13%) |
Rural location | 3,128 (2%) |
Results
Complication | Rate (# of cases) |
---|---|
Mortality | 0.68% (943) |
Dislocation | 1.39% (1,930) |
Infection | 0.70% (969) |
Thromboembolic disease | 0.64% (883) |
Perioperative fracture | 0.01% (14) |
Revision surgery | 0.93% (1,289) |
Neurovascular Injury | 0.05% (74) |
Overall rate of any complication within 90-days | 3.81% (5,277) |
Patient or hospital characteristic | Reference group | 90-day overall complication risk (Odds ratio, 95% confidence interval, p-value) |
---|---|---|
Patient characteristic | ||
Age > 75 | Age > 65–75 | 1.39 (1.30–1.48, p < 0.001) |
Age > 55–65 | Age > 65–75 | 0.89 (0.83–0.96, p = 0.005) |
Age ≤ 55 | Age > 65–75 | 0.72 (0.65–0.81, p < 0.001) |
Male gender | Female Gender | 1.10 (1.03–1.17, p = 0.02) |
Black race | White Race | 1.19 (1.05–1.35, p = 0.007) |
Hispanic ethnicity | White Race | 0.75 (0.67–0.85, p < 0.001) |
Asian race | White Race | 0.54 (0.42–0.69, p < 0.001) |
Income < 80th percentile | Income ≥ 20th percentile | 1.11 (0.97–1.27, p = 0.12) |
Patient comorbidity | ||
Charlson co-morbidity | Continuous variable | 1.21 (1.18–1.24, p < 0.001) |
Uncomplicated diabetes | Patients without diabetes | 1.31 (1.19–1.44, p < 0.001) |
Complicated diabetes | Patients without diabetes | 1.94 (1.49–2.53, p < 0.001) |
Peripheral vascular disease | Patients without PVD | 1.66 (1.30–2.11, p < 0.001) |
Rheumatoid disease | No rheumatoid disease |
1.53 (1.23–1.91, p < 0.001)
|
Hospital characteristics | ||
Low-volume hospitals | High-volume hospitals | 2.00 (1.82–2.20, p < 0.001) |
Intermediate volume hospitals | High-volume hospitals | 1.33 (1.22–1.45, p < 0.001) |
Teaching status | Non-teaching status | 1.05 (0.96–1.15, p = 0.30) |
Rural location | Non-rural location | 1.16 (0.97–1.38, p = 0.11) |
Patient or hospital characteristic | Reference group | 90-day mortality risk (Odds ratio, 95% confidence interval, p-value) | 90-day infection risk (Odds ratio, 95% confidence interval, p-value) | 90-day dislocation risk (Odds ratio, 95% confidence interval, p-value) | 90-day revision risk (odds ratio, 95% confidence interval, p-value) | 90-day thromboembolism risk (odds ratio, 95% confidence interval, p-value) |
---|---|---|---|---|---|---|
Patient characteristic | ||||||
Age > 75 | Age > 65–75 | 2.60 (2.22–3.04, p < 0.001) | 1.28 (1.09–1.51, p = .003) | 1.25 (1.12–1.40, p < 0.001) | 1.12 (0.96–1.31, p = 0.16) | 1.12 (0.96–1.31, p = 0.16) |
Age > 55–65 | Age > 65–75 | 0.61 (0.49–0.76, p < 0.001) | 1.10 (0.93–1.31, p = 0.26) | 0.91 (0.81–1.03, p = 0.14) | 0.72 (0.60–0.87, p < 0.001) | 0.72 (0.60–0.87, p < 0.001) |
Age ≤ 55 | Age > 65–75 | 0.26 (0.17–0.38, p < 0.001 |
1.34 (1.05–1.72, p = 0.02)
| 0.69 (0.58–0.83, p < 0.001) | 0.42 (0.30–0.57, p < 0.001) | 0.42 (0.30–0.57, p < 0.001) |
Male gender | Female gender | 1.23 (1.08–1.41, p = 0.002) | 1.14 (0.99–1.30, p = 0.06) | 1.16 (1.06–1.28, p = 0.001) | 1.06 (0.93–1.22, p = 0.37) | 1.06 (0.93–1.22, p = 0.37) |
Black race | White race | 1.21 (0.89–1.66, p = 0.23) | 1.34 (10.5–1.73, p = 0.02) | 0.98 (0.79–1.21, p = 0.83) | 1.89 (1.44–2.47, p < 0.001) | 1.89 (1.44–2.47, p < 0.001) |
Hispanic ethnicity | White race | 0.84 (0.62–1.13, p = 0.25) | 0.95 (0.74–1.21, p = 0.67) | 0.67 (0.55–0.83, p < 0.001) | 0.73 (0.53–1.01, p = 0.06) | 0.73 (0.53–1.01, p = 0.61) |
Asian race | White race | 1.27 (0.82–1.97, p = 0.29) | 0.87 (0.55–1.36, p = 0.54) | 0.41 (0.26–0.63, p < 0.001) | 0.33 (0.15–0.73, p = 0.006) | 1.17 (0.75–1.83, p = 0.49) |
Income < 80th percentile | Income ≥ 20th percentile | 1.09 (0.79–1.51, p = 0.58) | 1.62 (1.26–2.09, p < 0.001) | 1.18, (0.96–1.32, p = 0.12) |
0.68 (0.46–0.99, p = 0.047)
|
0.68 (0.46–0.99, p = 0.047)
|
Patient comorbidity | ||||||
Charlson co-morbidity | Continuous variable | 1.51 (1.45–1.58, p < 0.001) | 1.22 (1.15–1.28, p < 0.001) | 1.10 (1.05–1.15, p < 0.001) | 1.11 (1.04–1.19, p = 0.003) | 1.11 (1.04–1.19, p = 0.003) |
Uncomplicated diabetes | Patients without diabetes | 1.45 (1.18–1.77, p < 0.001) | 1.72 (1.42–2.08, p < 0.001) | 1.45 (1.25–1.67, p < 0.001) | 0.86 (0.67–1.11, p = 0.26) | 0.86 (0.67–1.11, p = 0.26) |
Complicated diabetes | Patients without diabetes | 2.65 (1.67–4.22, p < 0.001) | 3.70 (2.39–5.74, p < 0.001) | 1.42 (0.86–2.34, p = 0.17) | 1.04 (0.46–2.33, p = 0.93) | 1.04 (0.46–2.33, p = 0.93) |
Peripheral vascular disease | Patients without PVD | 2.00 (1.49–2.69, p < 0.001) | 1.31 (0.87–1.96, p = 0.20) | 1.12 (0.81–1.53, p = 0.49) | 1.10 (0.69–1.77, p = 0.69) | 1.10 (0.69–1.77, p = 0.69) |
Rheumatoid disease | No rheumatoid disease |
1.88 (1.17–3.03, p = 0.01)
| 1.47 (0.90–2.41, p = 0.12) | 1.50 (1.05–2.15, p = 0.26 | 1.46 (0.82–2.61, p = 0.20) | 1.46 (0.82–2.61, p = 0.20) |
Hospital characteristics | ||||||
Low-volume hospitals | High-volume hospitals | 1.82 (1.44–2.30, p < 0.001) | 2.35 (1.87–2.94, p < 0.001) | 2.43 (2.08–2.84, p < 0.001) | 1.78 (1.42–2.22, p < 0.001) | 1.78 (1.42–2.22, p < 0.001) |
Intermediate volume hospitals | High-volume hospitals | 1.45 (1.17–1.79, p = 0.001) | 1.48 (1.20–1.83, p < 0.001) | 1.40 (1.21–1.62, p < 0.001) | 1.22 (1.00–1.49, p = 0.05) | 1.22 (1.00–1.49, p = 0.046) |
Teaching status | Non-teaching status | 0.93 (0.74–1.17 p = 0.53) | 1.04 (0.85–1.28, p = 0.70) | 1.15 (0.99–1.33, p = 0.06) | 1.11 (0.90–1.36, p = 0.34) | 1.11 (0.90–1.36, p = 0.34) |
Rural location | Non-rural location | 0.97 (0.66–1.43, p = 0;88) | 1.42 (0.96–2.08, p = 0.08) | 0.90 (0.66–1.23, p = 0.52) |
1.77 (1.22–2.57, p = 0.003)
| 1.77 (1.22–2.57, p = 0.003) |
Discussion
Complication | 90-day mortality | 90-day dislocation | 90-day thromboembolic disease | 90-day infection | 30-day readmission rate | Overall rate of any complication within 90-days |
---|---|---|---|---|---|---|
Katz et al. [4] | 1.00% | 3.10% | 0.90% | 0.20% | Not reported | Not reported |
Swedish Registry [3] | 0.76% | Not reported | Not reported | Not reported | 3.90% | Not reported |
SooHoo et al. [current study] | 0.68% | 1.39% | 0.64% | 0.90% | Not reported | 3.81% |