Total elbow and hip arthroplasties confer greater short-term risk of postoperative complications: a matched cohort analysis of the five major joint arthroplasties.

Abstract

Background: Total joint arthroplasty (TJA) is a common orthopedic procedure.

Objective: The primary objective of this retrospective cohort study was to investigate 30-day postoperative complication rates following five major types of TJA (shoulder, elbow, hip, knee, ankle). Independent risk factors for adverse outcomes were also assessed.

Methods: The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was filtered using current procedural terminology (CPT) codes to identify patients undergoing TJA from 2015 to 2020. Patients were divided into cohorts by joint replaced. Nearest neighbor matching and statistical analyses were performed to compare complication rates between cohorts.

Results: A total of 605,158 patients were identified, with 457 patients included per matched cohort. Mean age was youngest in the ankle cohort. Operative time and proportion of patients with dependent functional status were greatest in the elbow cohort. Length of stay (LOS) and risk of any adverse event (AAE) were greatest for elbow and hip arthroplasty. Risk of AAE was lowest with ankle arthroplasty. Wound dehiscence and return to the operating room (OR) were most common following elbow arthroplasty. Postoperative blood transfusion occurred most often after hip arthroplasty. Operative time, LOS, BMI, American Society of Anesthesiologists (ASA) class, and preoperative blood transfusion were independently associated with postoperative complications.

Conclusion: Elbow and hip arthroplasty appear to confer greater risk of short-term postoperative complications compared to other TJA types. This data can help inform clinical decision-making and may facilitate adoption of measures within orthopedic practice to optimize outcomes and minimize financial burden.