Heart Failure is Associated with Early Medical and Surgery-Related Complications Following Total Hip Arthroplasty: A Propensity-Scored Analysis

• Published in: The Journal of arthroplasty 2023-05, Vol.38 (5), p.868-872.e4
• Main Authors: Sequeira, Sean B., Boucher, Henry R.
• Format: Article
• Language: English
• Subjects: Arthroplasty, Replacement, Hip - adverse effects; diastolic; heart failure; Heart Failure - epidemiology; Heart Failure - etiology; Heart Failure - surgery; Humans; Pneumonia - complications; Postoperative Complications - epidemiology; Postoperative Complications - etiology; postoperative outcomes; Propensity Score; Pulmonary Embolism; Retrospective Studies; Risk Factors; systolic; total hip arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.11.009

There is a paucity of literature that examines how heart failure (HF) impacts surgery-related complications following total hip arthroplasty (THA). We hypothesized that patients who had HF will be at increased risk of early medical- and surgery-related complications following THA. Patients who had HF and underwent primary THA between 2010 and 2019 were identified using a large national insurance database. Ninety-day incidence of various medical complications, surgery-related complications, and hospital utilizations were evaluated for patients who did and did not have HF, as well as subgroup analyses were performed on patients who were prescribed mortality-benefitting medications for HF 1 year prior to THA. Propensity score matching resulted in 34,000 HF patients who underwent primary THA and 340,000 matching patients. The HF cohort was associated with a higher 90-day incidence of pulmonary embolism (PE), deep vein thrombosis (DVT), transfusion, pneumonia, cerebrovascular accident (CVA), myocardial infarction (MI), sepsis, acute post hemorrhagic anemia, acute renal failure (ARF), and urinary tract infection (UTI), as well as 1-year risk of revision THA, periprosthetic joint infection (PJI), aseptic loosening, and dislocation compared to controls. The HF cohort was associated with a higher 90-day incidence of emergency department visits, readmissions, lengths of stay (LOS), and 1-year costs of care. The medication cohort was at decreased risk of PE, DVT, CVA, return to ED, readmission and MI within 90 days of surgery, and 1-year risk of revision THA and aseptic loosening. These findings may help to better risk-stratify patients who have HF and are scheduled to undergo THA, as well as call for additional surveillance of these patients in the immediate and early postoperative period. This study also helps surgeons and internists understand how chronic medications used to treat HF can impact medical- and surgery-related outcomes following THA.