European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2019
Hemiarthroplasty versus total hip arthroplasty for femoral neck fractures in patients with chronic obstructive pulmonary disease.
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Lee Danny, Lee Ryan, Tran Andrew, Shah Nidhi, Heyer Jessica H, Hughes Alice J, Pandarinath Rajeev
Аннотация
PURPOSE: This study sought to delineate whether total hip arthroplasty (THA) or hip hemiarthroplasty (HHA) had more complication rates following the treatment of femoral neck fractures (FNF) in chronic obstructive pulmonary disease (COPD) patients.
MATERIALS AND METHODS: The ACS-NSQIP database was queried for all patients with a history of COPD who had undergone THA and HHA with FNFs, isolated by CPT codes and ICD-9/ICD-10 codes. Propensity score matching without replacement in a 1:1 manner was done to control for patient demographics/preoperative comorbidities. Multivariate logistic regression models were utilized to assess the independent effect of HHA in comparison to THA.
RESULTS: The propensity-matched (PM) HHA cohort was significantly older (76.14 years vs. 73.33 years, p = 0.001) and had significantly higher rates of pneumonia (p = 0.017), extended length of stay (LOS) (p = 0.017), and mortality (p = 0.002), but lower rates of blood transfusions (p = 0.016) and reoperation (p = 0.020). HHA was independently associated with an increased risk of pneumonia (p = 0.043), extended LOS (p = 0.050), and death (p = 0.044) but a decreased risk for blood transfusions (p = 0.008) and reoperation (p = 0.028) when compared to THA.
DISCUSSION: Patients with more comorbidities are more likely to receive HHA than THA, which may explain some of the increased complications and mortality associated with HHA for FNFs compared to THA. Patients undergoing THA were at increased risk for blood transfusion and reoperation. THA does not appear to result in increased morbidity in this population compared to HHA. While THA should be considered in these patients given improved functional outcomes, further prospective studies are needed to establish superiority.
LEVEL OF EVIDENCE: III.
MATERIALS AND METHODS: The ACS-NSQIP database was queried for all patients with a history of COPD who had undergone THA and HHA with FNFs, isolated by CPT codes and ICD-9/ICD-10 codes. Propensity score matching without replacement in a 1:1 manner was done to control for patient demographics/preoperative comorbidities. Multivariate logistic regression models were utilized to assess the independent effect of HHA in comparison to THA.
RESULTS: The propensity-matched (PM) HHA cohort was significantly older (76.14 years vs. 73.33 years, p = 0.001) and had significantly higher rates of pneumonia (p = 0.017), extended length of stay (LOS) (p = 0.017), and mortality (p = 0.002), but lower rates of blood transfusions (p = 0.016) and reoperation (p = 0.020). HHA was independently associated with an increased risk of pneumonia (p = 0.043), extended LOS (p = 0.050), and death (p = 0.044) but a decreased risk for blood transfusions (p = 0.008) and reoperation (p = 0.028) when compared to THA.
DISCUSSION: Patients with more comorbidities are more likely to receive HHA than THA, which may explain some of the increased complications and mortality associated with HHA for FNFs compared to THA. Patients undergoing THA were at increased risk for blood transfusion and reoperation. THA does not appear to result in increased morbidity in this population compared to HHA. While THA should be considered in these patients given improved functional outcomes, further prospective studies are needed to establish superiority.
LEVEL OF EVIDENCE: III.