Association of Patient Sex With Inpatient Mortality After Elective Primary Total Hip Arthroplasty for Osteoarthritis.

Objective: This study aims to evaluate the association between patient sex and discharge disposition as well as inpatient mortality following elective primary total hip arthroplasty (THA) for osteoarthritis (OA) in the United States.

Methods: This study used the 2016-2019 US National Inpatient Sample, a nationally representative dataset, to conduct a cross-sectional study. Adjusted odds ratios and 95% confidence intervals (CIs) were calculated to assess the association of sex with discharge disposition and in-hospital mortality after elective primary THA for OA, adjusting for demographics, comorbidity, social determinants of health (income, insurance payer), hospital characteristics (bed size, location/teaching status, region, control), and postprocedural complications (for mortality and discharge disposition).

Results: There were 1,507,085 elective primary THA hospitalizations for OA in the 2016-2019 National Inpatient Sample data. The mean age was 65.6 years, 55.7% were female, and the mean Deyo-Charlson comorbidity index score was 0.6. In multivariable-adjusted analysis, compared with male sex, female sex was associated with nonhome discharge, but not with in-hospital mortality following elective THA for OA; the adjusted odds ratios were 1.27 (95% CI, 1.25-1.29; p < 0.001) and 0.72 (95% CI, 0.46-1.13; p = 0.15), respectively.

Conclusions: Female sex was a risk factor for nonhome discharge, but not in-hospital mortality after elective primary THA for OA. It remains to be seen whether better patient health optimization with clinical pathways and targeted interventions in females undergoing elective primary THA can reduce the complication rate.