In the JournalsPerspective

Dependent functional status prior to THA linked to worse postoperative outcomes

julius oni headshot
Julius K. Oni

Patients who required some or total assistance to perform activities of daily living prior to total hip arthroplasty experienced worse outcomes after surgery compared with patients who did not require assistance prior to surgery, according to results.

“Patients who preoperatively have to depend on others while performing some or all of their activities of daily living were more likely than independent patients to experience a major medical complication, have a long hospital stay and be discharged to a facility other than home,” Julius K. Oni, MD, co-author of the study, told Healio.com/Orthopedics.

Using the American College of Surgeons National Surgical Quality Improvement Program, Oni and colleagues categorized all patients who underwent primary THA for a principal diagnosis of osteoarthritis as either dependent or independent based on their preoperative functional status. The occurrence of a major medical complication within 30 days after surgery was considered the primary outcome, and researchers also examined length of hospital stay, unplanned reoperation for any reason within the same 30-day period and non-routine discharge.

Results showed patients in the dependent group were likely to be older and have more preoperative comorbidities. Researchers also found the dependent group was more likely to have a major complication within 30 days postoperatively, have higher rates of death, unplanned reintubation, acute renal failure, sepsis and deep surgical site infection compared with the independent group. The dependent group had a longer mean hospital stay, according to results, and were more likely to be discharged to a facility other than home and to have an unplanned reoperation.

Results showed major complications, non-routine discharge and longer hospital stay were predicted by preoperative dependent functional status after controlling for potential confounders. Multivariate analysis showed similar rates of unplanned reoperation between groups.

“With an aging society, we see an increased number of people who need or are referred for hip replacement surgeries,” Michael Raad, MD, first author of the study and a postdoctoral research fellow in the department of orthopedic surgery at the Johns Hopkins University School of Medicine, said in a press release. “However, without a better understanding of factors that influence outcomes after surgery, we may not be making the best treatment plans of our patients, and our study offers a simple tool to help inform treatment decisions.” – by Casey Tingle

 

Disclosures: Oni and Raad report no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

julius oni headshot
Julius K. Oni

Patients who required some or total assistance to perform activities of daily living prior to total hip arthroplasty experienced worse outcomes after surgery compared with patients who did not require assistance prior to surgery, according to results.

“Patients who preoperatively have to depend on others while performing some or all of their activities of daily living were more likely than independent patients to experience a major medical complication, have a long hospital stay and be discharged to a facility other than home,” Julius K. Oni, MD, co-author of the study, told Healio.com/Orthopedics.

Using the American College of Surgeons National Surgical Quality Improvement Program, Oni and colleagues categorized all patients who underwent primary THA for a principal diagnosis of osteoarthritis as either dependent or independent based on their preoperative functional status. The occurrence of a major medical complication within 30 days after surgery was considered the primary outcome, and researchers also examined length of hospital stay, unplanned reoperation for any reason within the same 30-day period and non-routine discharge.

Results showed patients in the dependent group were likely to be older and have more preoperative comorbidities. Researchers also found the dependent group was more likely to have a major complication within 30 days postoperatively, have higher rates of death, unplanned reintubation, acute renal failure, sepsis and deep surgical site infection compared with the independent group. The dependent group had a longer mean hospital stay, according to results, and were more likely to be discharged to a facility other than home and to have an unplanned reoperation.

Results showed major complications, non-routine discharge and longer hospital stay were predicted by preoperative dependent functional status after controlling for potential confounders. Multivariate analysis showed similar rates of unplanned reoperation between groups.

“With an aging society, we see an increased number of people who need or are referred for hip replacement surgeries,” Michael Raad, MD, first author of the study and a postdoctoral research fellow in the department of orthopedic surgery at the Johns Hopkins University School of Medicine, said in a press release. “However, without a better understanding of factors that influence outcomes after surgery, we may not be making the best treatment plans of our patients, and our study offers a simple tool to help inform treatment decisions.” – by Casey Tingle

 

Disclosures: Oni and Raad report no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

    Perspective
    Jonathan R. Danoff

    Jonathan R. Danoff

    It has been well established that optimizing a patient’s health prior to THA through smoking cessation, weight loss, maximizing nutrition, controlling diabetes and avoidance of anemia can mitigate surgical risk and improve patient outcomes, while decreasing costs. Raad and colleagues utilized the NSQIP database identifying a cohort of 43,179 patients undergoing THA and examined the role a patient’s preoperative functional independence influences postoperative outcomes in total hip arthroplasty.

    The authors found that patients who require a home health aid or a family member to assist them in their home environment for daily function preoperatively were more at risk for postoperative complications, longer hospital stays and failure to discharge back to home, resulting in overall increased costs. As we move to bundled care models of reimbursement, it will be increasingly important for surgeons to identify strategies to intervene in the elderly, dependent patient population to mitigate these risks factors and decrease costs.

    • Jonathan R. Danoff, MD
    • Adult joint reconstruction orthopedic surgeon
      Northwell Health Orthopedic Institute
      Great Neck, New York

    Disclosures: Danoff reports no relevant financial disclosures.