Outcomes Following Primary Total Hip or Knee Arthroplasty in Substance Misusers

https://doi.org/10.1016/j.arth.2015.01.052Get rights and content

Abstract

The influence of drug misuse on outcomes following primary total hip (THA) or knee (TKA) arthroplasty is poorly understood. The National Hospital Discharge Survey was used to identify patients who underwent primary THA or TKA between 1990 and 2007. Patients were divided into two groups: 1) those with a diagnosis of drug misuse (cannabis, opioids, cocaine, amphetamines, sedatives, inhalants or mixed combinations) (n = 13,163) and 2) those with no diagnosis of misuse (n = 8,366,327). Patients with a diagnosis of drug misuse had longer hospital stays (P < 0.001), nearly eight times the odds of leaving against medical advice (P < 0.001) and five times the mortality rate (P < 0.001). Drug misuse was associated with higher odds (P < 0.001) of complications including postoperative infection, anemia, convulsions, osteomyelitis, and blood transfusion.

Section snippets

Data Source

The National Hospital Discharge Survey (NHDS) [13], developed by the National Center for Healthcare Statistics Division of the Centers for Disease Control and Prevention (CDC), was used in this study. The NHDS is considered the most comprehensive of all inpatient surgical databases in use today and is the principal database used by the U.S. government for monitoring hospital use [14]. Publicly available, the NHDS provides demographic and medical data for inpatients discharged from non-federal,

Results

A cohort representative of 8,379,490 patients who underwent primary THA or TKA between 1990 and 2007 was identified (Table 1). Of the total cohort, 13,163 patients had a diagnosis of drug misuse, while 8,366,327 patients had no diagnosis of drug misuse. The drug misuse group was younger (51.6 ± 12.9 years compared to 67.3 ± 11.7 years; P < 0.001), had longer hospital stays (5.3 ± 4.0 days compared to 5.1 ± 4.2 days; P < 0.001), and had a higher rate of patients who left against medical advice (0.4% compared to

Discussion

This study describes the influence of drug misuse on perioperative outcomes following primary THA or TKA. Although individuals who misuse drugs are thought to be at increased risk of inflammatory arthropathies, the indication for surgery in this population is complicated by a higher risk of infection 7., 8.. The results of this study show that patients who misuse drugs face prolonged hospital lengths of stay and higher odds of leaving against medical advice, mortality and complications

References (32)

  • American Psychiatric Association (APA)

    Diagnostic and statistical manual of mental disorders

    Text revision

    (2000)
  • H.J. Harwood et al.

    Economic costs of alcohol abuse and alcoholism

    Recent Dev Alcohol

    (1998)
  • D. McKusick et al.

    Spending for mental health and substance abuse treatment, 1996

    Health Aff (Millwood)

    (1998)
  • National Institute on Drug Abuse

    Drug abuse and addiction: 25 years of discovery to advance the health of the people: the sixth triennial report to Congress from the secretary of Health and Human Services

    (1999)
  • Office of National Drug Control Policy

    The economic costs of drug abuse in the United States, 1992–1998

    (2001)
  • W.M. Compton et al.

    Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions

    Arch Gen Psychiatry

    (2007)
  • K. Wieser et al.

    Total hip replacement in patients with history of illicit injecting drug use

    Arch Orthop Trauma Surg

    (2012)
  • J.L. Lamas et al.

    Asymptomatic osteonecrosis of the hip in HIV-infected patients

    Enferm Infecc Microbiol Clin

    (2010)
  • F.D. Lowy et al.

    New methods to investigate infectious disease transmission and pathogenesis--Staphylococcus aureus disease in drug users

    Lancet Infect Dis

    (2002)
  • R.J. Gordon et al.

    Bacterial infections in drug users

    N Engl J Med

    (2005)
  • Y.H. Yu et al.

    Acute delirium and poor compliance in total hip arthroplasty patients with substance abuse disorders

    J Arthroplasty

    (2012)
  • C.R. Lehman et al.

    Infection after total joint arthroplasty in patients with human immunodeficiency virus or intravenous drug use

    J Arthroplasty

    (2001)
  • Centers for Disease Control and Prevention

    National Hospital Discharge Survey

  • C. Dennison et al.

    Design and operation of the National Hospital Discharge Survey: 1988 redesign

    Vital Health Stat

    (2000)
  • CDC/National Center for Health Statistics

    International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

  • S.G. Memtsoudis et al.

    In-hospital complications and mortality of unilateral, bilateral, and revision TKA: based on an estimate of 4,159,661 discharges

    Clin Orthop Relat Res

    (2008)
  • Cited by (0)

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.01.052.

    1

    Medical student, University of Miami Miller School of Medicine, Miami, FL, USA.

    2

    University of Miami Department of Orthopaedic Surgery and Rehabilitation, Miami, FL, USA.

    3

    Vice chair, Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.

    View full text