How Systemic Sclerosis Affects Healthcare Use and Complication Rates after Total Hip Arthroplasty

Abstract

Objective.To assess whether outcomes after primary total hip arthroplasty (THA) differ in systemic sclerosis (SSc).Methods.We used the 1998–2014 US National Inpatient Sample. THA and SSc were identified using procedure and diagnostic codes, respectively. Multivariable-adjusted logistic regression analyses assessed the association of SSc with in-hospital complications (implant infection, revision, transfusion, mortality) post-THA and associated healthcare use (hospital charges, hospital stay, discharge to non-home setting), adjusting for age, sex, race, Deyo-Charlson comorbidity index, primary diagnosis for THA, household income, and insurance payer.Results.Of the 4,116,485 primary THA performed in the United States in 1998–2014, SSc patients made up 0.06% (n = 2672). In multivariable-adjusted analyses, compared to people without SSc, people with SSc had higher adjusted OR (95% CI) of the following post-primary THA: (1) non-home discharge, 1.25 (95% CI 1.03–1.50); (2) hospital stay > 3 days, 1.61 (95% CI 1.35–1.92); (3) transfusion, 1.54 (95% CI 1.28–1.84); and (4) in-hospital revision, 9.53 (95% CI 6.75–13.46). Differences in in-hospital mortality had a nonsignificant trend [2.19 (95% CI 0.99–4.86)]. There were no differences in total hospital charges or implant infection rates.Conclusion.SSc was associated with a higher rate of in-hospital complications and healthcare use after primary THA. Future studies should examine whether pre- or postoperative interventions can reduce the risk of post-THA complications in people with SSc.