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Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study.
J Arthroplasty. 2018 07; 33(7S):S162-S166.JA

Abstract

BACKGROUND

Parkinson disease (PD) is the second most common neurodegenerative disorder in the United States, affecting over 1 million people. As part of the disease process, PD can cause poor bone quality and other musculoskeletal problems that can affect a patient's quality of life. With advances in treatment, PD patients can be more active and may be candidates for total hip arthroplasty (THA). However, there is a paucity of literature on the outcomes of THA in PD patients. Therefore, the purpose of this study was to evaluate the perioperative outcomes of PD patients who underwent THA. Specifically, we assessed: (1) perioperative surgical and medical complications; (2) lengths of stay (LOSs); and (3) total hospital charges.

METHODS

Using the Nationwide Inpatient Sample, patients who had PD and underwent THA between 2002 and 2013 were identified. With the use of propensity scores, PD patients were matched in a 1:3 ratio to patients without PD by the year of surgery, age, gender, race, Charlson/Deyo score, and insurance type. This yielded a total of 10,519 PD and 31,679 non-PD THA patients. Regression analyses were used to compare the risk of perioperative complications (any, surgical, medical), the percent differences in mean LOS, and the percent differences in total hospital charges.

RESULTS

Compared with the matched cohort, PD patients had a 52% higher risk for any complication (odds ratio [OR] = 1.52; 95% confidence interval [CI], 1.37-1.69), a 30% higher risk for any surgical complication (OR = 1.30; 95% CI: 0.88-1.91), and a 54% higher risk for any medical complication (OR = 1.54; 95% CI, 1.38-1.71). Specifically, PD patients were more likely to have postoperative delirium (OR = 2.61; 95% CI: 1.77-3.85), altered mental status (OR = 3.01; 95% CI: 1.35-6.71), urinary tract infection (OR = 1.34; 95% CI: 1.09-1.76), and blood transfusion (OR = 1.62; 95% CI: 1.44-1.82). Also, PD patients had a mean LOS that was 8.57% longer (P < .0001), and mean total hospital charges that were 3.85% higher (P < .0001).

CONCLUSION

Orthopedic surgeons and neurologists should be involved in the preoperative counseling of PD patients regarding their potential increased risks associated with THA, which could help optimize their preoperative care. Furthermore, the risk of complications and higher costs could potentially lead to the development of different reimbursement methods in this population of patients.

Authors+Show Affiliations

Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Neurology, TeleSpecialists, Fort Myers, Florida.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29402715

Citation

Newman, Jared M., et al. "Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? a Nationwide Database Study." The Journal of Arthroplasty, vol. 33, no. 7S, 2018, pp. S162-S166.
Newman JM, Sodhi N, Dalton SE, et al. Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study. J Arthroplasty. 2018;33(7S):S162-S166.
Newman, J. M., Sodhi, N., Dalton, S. E., Khlopas, A., Newman, R. P., Higuera, C. A., & Mont, M. A. (2018). Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study. The Journal of Arthroplasty, 33(7S), S162-S166. https://doi.org/10.1016/j.arth.2018.01.006
Newman JM, et al. Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? a Nationwide Database Study. J Arthroplasty. 2018;33(7S):S162-S166. PubMed PMID: 29402715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study. AU - Newman,Jared M, AU - Sodhi,Nipun, AU - Dalton,Sarah E, AU - Khlopas,Anton, AU - Newman,Richard P, AU - Higuera,Carlos A, AU - Mont,Michael A, Y1 - 2018/01/16/ PY - 2017/10/18/received PY - 2017/12/19/revised PY - 2018/01/04/accepted PY - 2018/2/7/pubmed PY - 2019/3/5/medline PY - 2018/2/7/entrez KW - Parkinson disease KW - lengths of stay KW - perioperative complications KW - total hip arthroplasty KW - total hospital charges SP - S162 EP - S166 JF - The Journal of arthroplasty JO - J Arthroplasty VL - 33 IS - 7S N2 - BACKGROUND: Parkinson disease (PD) is the second most common neurodegenerative disorder in the United States, affecting over 1 million people. As part of the disease process, PD can cause poor bone quality and other musculoskeletal problems that can affect a patient's quality of life. With advances in treatment, PD patients can be more active and may be candidates for total hip arthroplasty (THA). However, there is a paucity of literature on the outcomes of THA in PD patients. Therefore, the purpose of this study was to evaluate the perioperative outcomes of PD patients who underwent THA. Specifically, we assessed: (1) perioperative surgical and medical complications; (2) lengths of stay (LOSs); and (3) total hospital charges. METHODS: Using the Nationwide Inpatient Sample, patients who had PD and underwent THA between 2002 and 2013 were identified. With the use of propensity scores, PD patients were matched in a 1:3 ratio to patients without PD by the year of surgery, age, gender, race, Charlson/Deyo score, and insurance type. This yielded a total of 10,519 PD and 31,679 non-PD THA patients. Regression analyses were used to compare the risk of perioperative complications (any, surgical, medical), the percent differences in mean LOS, and the percent differences in total hospital charges. RESULTS: Compared with the matched cohort, PD patients had a 52% higher risk for any complication (odds ratio [OR] = 1.52; 95% confidence interval [CI], 1.37-1.69), a 30% higher risk for any surgical complication (OR = 1.30; 95% CI: 0.88-1.91), and a 54% higher risk for any medical complication (OR = 1.54; 95% CI, 1.38-1.71). Specifically, PD patients were more likely to have postoperative delirium (OR = 2.61; 95% CI: 1.77-3.85), altered mental status (OR = 3.01; 95% CI: 1.35-6.71), urinary tract infection (OR = 1.34; 95% CI: 1.09-1.76), and blood transfusion (OR = 1.62; 95% CI: 1.44-1.82). Also, PD patients had a mean LOS that was 8.57% longer (P < .0001), and mean total hospital charges that were 3.85% higher (P < .0001). CONCLUSION: Orthopedic surgeons and neurologists should be involved in the preoperative counseling of PD patients regarding their potential increased risks associated with THA, which could help optimize their preoperative care. Furthermore, the risk of complications and higher costs could potentially lead to the development of different reimbursement methods in this population of patients. SN - 1532-8406 UR - https://www.unboundmedicine.com/medline/citation/29402715/Does_Parkinson_Disease_Increase_the_Risk_of_Perioperative_Complications_After_Total_Hip_Arthroplasty_A_Nationwide_Database_Study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-5403(18)30014-7 DB - PRIME DP - Unbound Medicine ER -