Total Joint Arthroplasty Complication and Revision Surgery Rates Vary by Region and Season: Analysis of a Large Nationwide Database

Background: Total joint arthroplasty (TJA) is a highly successful surgical intervention, but a subset of patients will experience postoperative complications—with some cases even needing a revision surgery. This study investigated the effects of region and season on 90-day complication rates and 1-year revision surgery rates for TJA patients. Methods: We queried the American Academy of Orthopaedic Surgeons American Joint Replacement Registry for primary TJA conducted between 2018 and 2020. Multivariable logistic regression was conducted to investigate the effects of region, season, or their interaction on the risk of complications within 90 days and the risk of revision surgery within 1 year after adjusting for race, surgery year, age group, procedure, and Charlson Comorbidity Index score. Unmeasured variables including hospital volume and surgeon ability were controlled for as nested random effects in the model. Bonferroni-adjusted LSMeans were used to compare each season, region, and season within each region. Results: The risk of complications in the West was significantly higher than in the Northeast (aOR = 2.76, P < 0.001), Midwest (aOR = 2.44, P < 0.001), or South (aOR = 3.33, P < 0.001). The West also had a significantly higher risk of revision surgery than the South (aOR = 1.27, P = 0.038). These trends held across each season. Fall procedures had a significantly lower risk of both complication and revision surgery than those in the summer (aOR = 0.85, P < 0.001; aOR = 0.77, P < 0.001) or winter (aOR = 0.89, P = 0.024; aOR = 0.73, P < 0.001). Analysis of regional-seasonal interaction found that within the Northeast, fall surgeries had a significantly lower risk of revision surgery than spring surgeries (aOR = 0.64, P = 0.003). Conclusion: Our study found a statistically significant increase in the risk of complication in the West compared with the Northeast, Midwest, and South. Patients in the South also had a demonstrably lower risk of revision surgery than those in the West. Seasonally, fall TJA operations demonstrated a lower risk of both complication and revision surgery compared with summer or winter operations.