Patients who undergo elective arthroscopic hip surgery may experience a substantial increase in major clinical comorbidities up to 2 years postoperatively, according to results of a study published in British Journal of Sports Medicine.
“There are potentially lifestyle factors associated with these surgeries that we may not be doing our best job at screening for with patients that undergo these types of surgeries; factors that can potentially affect our outcomes,” Daniel I. Rhon, DSc, co-author of the study and assistant professor at Duke University, told Orthopedics Today. “I think this just brings more awareness to the fact there are other determinants of good or bad outcomes after surgery other than just maybe the procedure alone.”
Rise in comorbid conditions
Using the U.S. Military Health System Data Repository, Rhon and his colleagues collected and aggregated person-level data over 36 months for 1,870 patients undergoing arthroscopic hip surgery for femoroacetabular impingement between 2004 and 2013. Researchers examined mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders 12 months prior and 24 months after surgery, and calculated changes in frequencies and differences in proportions or comorbidities between pre-surgery and post-surgery.
After surgery, results showed statistically significant increases proportionally for all comorbidities. Researchers noted an increase in mental health disorder cases by 84%, in substance abuse disorders by 57%, in cardiovascular disorders by 71%, in metabolic syndrome cases by 85.9%, in systemic arthropathy by 132% and in sleep disorders by 111% post-surgery compared with pre-surgery. There was also a 166% increase in chronic pain diagnoses post-surgery.
“The hypothesis was that some of these comorbidities would be higher, but every single comorbidity that we looked at —and we chose comorbid conditions that are associated with orthopedic outcomes —rose after surgery, so that was surprising,” Rhon said.
Preoperative screening of patients
Although there was an association between surgery and an increase in these comorbidities, Rhon emphasized in the interview that this study could not confirm whether comorbidities were caused by the surgery.
“Based on the limitations of the data, we cannot say the surgery is what caused the comorbidities,” he said. “We just know there is a much higher rate of comorbidities afterwards.”
Due to these findings, Rhon said it is important for surgeons to screen patients preoperatively for these comorbidities that may be impacted by surgery, such as having patients complete sleep screening questionnaires and reviewing patients’ overall nutrition and physical activity levels.
“I think just broadening our outlook on how to manage these patients can likely lead to better improvements and better surgical outcomes down the road,” Rhon said. – by Casey Tingle
- Rhon DI, et al. Br J Sports Med. 2018;doi:10.1136/bjsports-2018-099294.
- For more information:
- Daniel I. Rhon, DSc, can be reached at 2400 Pratt St., Durham, NC 27705; email: firstname.lastname@example.org.
Disclosure: Rhon reports he has no relevant financial disclosures.