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Background: Treatment options for metastatic osseous lesions of the proximal femur include hemiarthroplasty (HA) or total hip arthroplasty (THA) depending on lesion characteristics and patient demographics. Studies assessing short-term outcomes after HA/THA in this patient population are limited. Therefore, the purpose of this present study was to identify short-term rates of morbidity and mortality after HA/THA for pathological proximal femur fractures, as well as readmission and reoperation rates and reasons., Methods: This study utilized a large, prospectively collected registry to identify patients who underwent HA/THA between 2011 and 2018. Patients were stratified by indication for surgery, including pathological fracture, nonpathological fracture, and osteoarthritis. Baseline patient characteristics and postoperative complications were compared using bivariate and/or multivariate analysis., Results: In total, 883 patients undergoing HA/THA for a pathological fracture were identified. Relative to an osteoarthritis cohort, these patients tended to be older, had a lower body mass index, and had significantly more preoperative comorbidities. These patients had high rates of total complications (13.93%), including thirty-day mortality (3.29%), unplanned return to the operating room (4.98%), and pulmonary complications (3.85%). Patients with pathological fracture had a longer operative duration relative to osteoarthritis and nonpathological cohorts (+27 and +25 minutes, respectively), despite having high rates of HAs performed., Conclusion: Patients undergoing hip arthroplasty for pathologic proximal femur fracture have increased morbidity and mortality relative to an osteoarthritis cohort. However, patients with a pathological fracture have similar rates of morbidity and mortality when compared with a nonpathological fracture cohort, but did experience higher rates of perioperative blood transfusion and unplanned readmissions., Level of Evidence: III., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Prolonged operative duration is an independent risk factor for postoperative complications in many orthopedic procedures ranging from shoulder arthroscopy to total hip and knee arthroplasties. It has not been well studied in unicompartmental knee arthroplasty (UKA). The purpose of this study is to assess the effect of operative duration on complications after UKA., Methods: Using the American College of Surgeons National Surgical Quality Improvement Program registry, we identified all primary unilateral UKAs from 2005 to 18. Patients were divided into three cohorts based on the operative duration: < 90 minutes, between 90 and 120 minutes, and >120 minutes. Baseline patient and operative demographics (age, gender, etc.) and thirty-day complications were compared using bivariate analysis. Multivariate analysis was used to assess the independent effect of operative duration on postoperative outcomes after adjusting for differences in baseline characteristics., Results: We identified 11,806 patients who underwent primary UKA from 2005 to 18. There was no difference in the "any complication" rate between cohorts. However, operative duration >120 minutes was associated with a significantly higher likelihood of reoperation (odds ratio [OR] 2.02, 95% confidence interval [CI]: 1.15-3.57, P = .015), non-home discharge (OR: 2.14, CI: 1.65-2.77, P < .001), surgical site infection (OR: 1.76, CI: 1.03-3.01, P = .038), and blood transfusions (OR: 3.23, CI: 1.44-7.22, P = .004) when compared with operative duration <90 minutes. There was no difference in mortality rates., Conclusion: Increased operative duration greater than 2 hours in primary UKA is associated with an increased risk of non-home discharge, surgical site infection, reoperation, and blood transfusion., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Current literature suggests that preoperative hematocrit levels may play an important role in determining risk for complications after total hip arthroplasty (THA). The purpose of this study was to determine the role of preoperative anemia status on 30-day complications after THA., Methods: Using the National Surgical Quality Improvement Program registry from 2006 to 2016, we identified all patients who underwent primary THA. Patients were placed into 3 cohorts based on preoperative hematocrit levels (normal > 36% [N = 166,538], mild anemia 27%-36% [N = 13,214], and severe anemia <27% [N = 541]). Differences in 30-day postoperative medical complications and readmission rates were compared using bivariate and multivariate analyses., Results: Multivariate logistic regression analysis identified mild anemia compared with normal hematocrit as a significant risk factor for total complications (OR: 1.46, P < .001), mortality (OR: 2.06, P < .001), renal complications (OR: 2.59, P < .001), respiratory complications (OR: 1.89, P < .001), sepsis (OR: 2.01, P < .001), wound infection (OR: 1.36, P < .001), and urinary tract infection (OR: 1.44, P < .001). Severe anemia was also risk factor, with a higher odds ratio, for total complications (OR: 1.99, P < .001). Both mild and severe anemia were significant risk factors for increased rates of perioperative blood transfusion (mild: OR, 4.04, severe: OR, 5.58), nonhome discharge (OR: 1.74, OR: 1.64), and unplanned hospital readmissions (OR: 1.42, OR: 1.66)., Conclusion: Preoperative anemia is a significant risk for perioperative complications after primary THA. Even mild anemia can lead to significantly increased risks of mortality, medical complications, and unplanned hospital readmissions in THA. This study further supports the need for screening and preoperative intervention for patients in this at-risk group., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Studies have identified a possible morbidity and mortality benefit with expedited time to surgery after a native hip fracture. This association after hip periprosthetic fractures (PPF) has been less clearly delineated. The purpose of this study is to assess the effect of time to surgery on rates of 30-day complications., Methods: The National Surgical Quality Improvement Program registry was used to identify all patients who underwent surgical intervention for hip PPF between 2005 and 2016. Patients were stratified into 2 cohorts based on time from hospital admission to surgery, either ≤24 hours (expedited) or >24 hours (non-expedited). Thirty-day outcome variables were assessed using bivariate and multivariate analyses., Results: We identified 857 patients undergoing surgical intervention for hip PPF, of whom 402 (46.9%) underwent expedited surgery and 455 (53.1%) underwent non-expedited surgery. Patients with non-expedited surgery had an average time to surgery of 2.4 days (range, 1-14 days). Multivariate analysis adjusting for differences in baseline patient characteristics revealed that patients with a non-expedited procedure had higher rates of overall complications (odds ratio [OR] = 1.72; P = .014), respiratory complications (OR = 4.15; P = .0029), urinary tract infections (OR = 2.77; P = .020), nonhome discharge (OR = 2.22; P < .001), and blood transfusions (OR = 1.86; P < .001). There was no statistical difference in mortality (P = .093). Patients with non-expedited surgery also had longer total and postoperative (+2.7 days; P < .001) length of stay., Conclusion: This study did not identify any statistical difference in mortality but found an association with increased postoperative complications and non-expedited surgery for PPF. Additional prospective studies may be warranted to identify the causative factors behind this association., (Copyright © 2019. Published by Elsevier Inc.)

Background: Hospital length of stay (LOS) is a quality metric and target of recent efforts in the last decade to decrease healthcare costs and postoperative nosocomial complications after total knee arthroplasty (TKA). However, decreasing LOS has raised concerns of possible increased complication and readmission rates. We present a decade-long analysis in trends of LOS and 30-day complication and unplanned readmissions following TKA., Methods: The National Surgical Quality Improvement Program registry was utilized to identify patients undergoing elective primary TKA between 2006 and 2016. Three cohorts of patients were created based on year of surgery (2006-2009 [N = 7111], 2010-2013 [N = 71,943], and 2014-2016 [N = 142,710]). Patient demographics, perioperative variables, LOS, 30-day postoperative complications, and readmission rates were analyzed between the 3 cohorts using bivariate and multivariate analyses., Results: LOS decreased significantly over time when the 2006-2009 cohort (3.7 days) was compared to the 2010-2013 cohort (3.3 days, P < .001) and 2014-2016 cohort (3.0 days, P < .001). Similarly, there was a decrease in the rate of total 30-day complications in the 2006-2009 cohort (5.37%) compared to 2010-2013 (3.86%) and 2014-2016 (3.13%, P < .001), with significantly lower rates of deep vein thrombosis, sepsis, and urinary tract infection in the latter cohorts. Decreasing rates of 30-day readmission were also observed in the 2010-2013 cohort (3.63%) compared to 2013-2016 cohort (3.23%, P < .001)., Conclusion: In the last decade, there has been a trend toward decreasing LOS after TKA. Despite concerns about early discharge, data from a national registry demonstrated a simultaneous decrease in total 30-day complication and readmission rates., Level of Evidence: III, Retrospective cohort study., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Background: In an attempt to decrease costs without increasing complication burden, the development of rapid recovery protocols has led to an increased push for decreased length of hospital stay (LOS) following total hip arthroplasty (THA). The purpose of this study was to analyze trends in LOS and complications following THA over a 10-year period., Methods: Using the National Surgical Quality Improvement Program registry from 2006 to 2016, we identified all patients who underwent primary THA. Patients were placed into 3 cohorts based on the year of surgery (2006-2009 [N = 3873], 2010-2013 [N = 45,992], 2014-2016 [N = 86,099]). Differences in LOS, operative time, readmission rates, and 30-day postoperative medical complications were compared using bivariate and multivariate analyses., Results: Multivariate regression analysis identified a significant decrease in LOS in days for the 2010-2013 cohort (3.2 ± 4.8, P < .001) and 2014-2016 cohort (2.7 ± 2.5, P < .001) compared to the 2006-2009 cohort (3.8 ± 2.5). Despite decreasing LOS, there were significantly lower complications in the later cohorts, with significantly lower rates of all complications (5.27% [2006-2009], 3.77% [2009-2013], 3.14% [2013-2016]), sepsis (0.70%, 0.31%, 0.16%), and urinary tract infection (1.94%, 1.23%, 0.83%) using both bivariate and multivariate analyses (P < .001). In addition, there was no significant difference in unplanned 30-day readmissions (3.66% [2010-2013] vs 3.5% [2014-2016], P = .142)., Conclusion: Over the last decade, there has been a decrease in LOS and an improved short-term complication profile for THA. With continually increasing rates of utilization of THA along broader patient demographics, these changes are important to help mitigate the costs of higher volume., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is associated with significant morbidity and cost. The purpose of this study was to determine how rates of perioperative complications, operative duration, and postoperative length of stay (LOS) in patients undergoing revision THA for PJI compare to primary THA and to revision THA for non-PJI., Methods: We used the National Surgical Quality Improvement Program registry from 2005 to 2015 to identify all patients who underwent primary and revision THA. Patients were placed into cohorts based on the surgical procedure and by indication, including (1) primary THA, (2) revision THA for PJI, and (3) revision THA for non-PJI. Differences in 30-day postoperative medical complications, hospital readmissions, operative duration, and LOS were compared using bivariate and multivariate analyses., Results: One lakh fourteen thousand five hundred five THA patients were identified, with 102,460 (89.5%) patients undergoing a primary THA and 12,045 (10.5%) undergoing a revision procedure. Of the 12,045 revision procedures, 10,777 (89.5%) were for non-PJI indications and 1268 (10.5%) were for PJI. Relative to primary THA, patients undergoing revision THA for PJI had an increased rate of total complications (odds ratio [OR] 3.96), sepsis (OR 13.15), deep surgical site infections (SSIs, OR 8.58), superficial SSI (OR 2.14, P = .002), nonhome discharge (OR 1.85), readmissions (OR 2.46), LOS (+3.0 days), and operative duration (+61 minutes). Compared with non-PJI revisions, PJI revisions had an increased rate of total complications (OR 2.42), sepsis (OR 5.51), deep SSI (OR 2.12), nonhome discharge (OR 1.47), and LOS (+1.8 days)., Conclusion: Revision THA for PJI is associated with increased postoperative complications, nonhome discharge, and LOS relative to non-PJI revision THA. Separate care pathways and reimbursement bundles should be considered for patients with PJI., Level of Evidence: III., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: Periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) is a devastating complication. The short-term morbidity profile of revision TKA performed for PJI relative to non-PJI revisions is poorly characterized. The purpose of this study is to determine 30-day postoperative outcomes after revision TKA for PJI, relative to primary TKA and aseptic revision TKA., Methods: The American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2015 was queried for primary and revision TKA cases. Revision TKA cases were categorized into PJI and non-PJI cohorts. Differences in 30-day outcomes including postoperative complications, readmissions, operative time, and length of stay were compared using bivariate and multivariate analyses., Results: In total, 175,761 TKAs were included in this study, with 162,981 (92.7%) primary TKAs and 12,780 (7.3%) revision TKAs, of which 2196 (17.2%) revisions were performed for PJI. When compared to aseptic revision TKA, multivariate analysis demonstrated that PJI revisions had a significantly higher risk of major early postoperative complications including death (adjusted odds ratio [OR] 3.25) and sepsis (OR 8.73). In addition, nonhome discharge (OR 1.75), readmissions (OR 1.67), and length of stay (+2.1 days) were all greater relative to non-PJI revisions., Conclusion: Utilizing a large, prospectively collected, national database, we found that revision TKA for PJI has a greater risk of short-term morbidity and mortality and requires a higher utilization of healthcare resources. These results have implications for patient counseling and alternative payment models that may eventually include revision TKA., (Copyright © 2017 Elsevier Inc. All rights reserved.)