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A National Analysis of Complications Following Total Hip Replacement in Patients With Chronic Obstructive Pulmonary Disease

View Article: PubMed Central - PubMed

ABSTRACT

Patients with chronic obstructive pulmonary disease (COPD) have a high risk of osteoporosis and fractures. The incidence rate of hip fracture has steadily increased over time and is a major common event in patients with osteoporosis and COPD. Total hip replacement (THR) is commonly performed in patients with hip fracture. Our aim was to compare the complications of THR between patients with and without COPD.

Longitudinally linked data from the National Health Insurance Research Database, which consists of registration, claims, and reimbursement records, for a cohort of 1,000,000 randomly selected enrollees traced retrospectively from 1996 to 2000 in Taiwan. Patients who had undergone THR surgery between January 1, 2004, and December 31, 2008, were identified and divided into COPD and non-COPD cohorts. Outcomes and complications, including 90-day mortality, 1-year mortality, 1-year wound infection, 30-day readmission for hospitalization, 30-day pneumonia, 30-day acute respiratory failure, 30-day cerebrovascular accident, and length of stay during hospitalization, were measured after THR.

The COPD group had a significantly higher ratio of complications, including 30-day readmission (14.0% vs 8.4%), 30-day pneumonia (10.4% vs 4.4%), 30-day acute respiratory failure (1.5% vs 0.5%), 1-year mortality (6.9% vs 2.7%), and length of stay in the hospital (10.6% vs 0.8%) than the non-COPD group.

In addition to airway diseases, patients in the COPD group had higher mortality than those in non-COPD group after THR. Surgeons should give more attention to airway evaluation and selection of patients with COPD for THR.

No MeSH data available.


Flowchart of the patients included in the study.
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Figure 1: Flowchart of the patients included in the study.

Mentions: Our study cohort consisted of patients who underwent THR surgery between January 1, 2004, and December 31, 2008, and were identified by ICD-9-CM codes 81.51 (THR), 81.52 (partial hip replacement), and 81.53 (revision of hip replacement) that were listed as the major operation in the NHIRD database. During the study period, only the data from the first-time THR registries were analyzed to ensure the independence of observations. The exclusion criteria included age <40 years and diagnosis with cancers before THR surgery (found ICD-9-CM 140–239 codes 3 years before the surgery date). In total, 2426 qualified patients who had THR surgery were preliminarily retrieved after the exclusion filtering (Figure 1). To investigate the complications of THR patients with a COPD history, the study cohort was divided into COPD and non-COPD groups in which the COPD patients were identified by the diagnostic codes (ICD-9-CM 490–492, 496) within 2 years before the THR surgery from their inpatient and outpatient records.


A National Analysis of Complications Following Total Hip Replacement in Patients With Chronic Obstructive Pulmonary Disease
Flowchart of the patients included in the study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998405&req=5

Figure 1: Flowchart of the patients included in the study.
Mentions: Our study cohort consisted of patients who underwent THR surgery between January 1, 2004, and December 31, 2008, and were identified by ICD-9-CM codes 81.51 (THR), 81.52 (partial hip replacement), and 81.53 (revision of hip replacement) that were listed as the major operation in the NHIRD database. During the study period, only the data from the first-time THR registries were analyzed to ensure the independence of observations. The exclusion criteria included age <40 years and diagnosis with cancers before THR surgery (found ICD-9-CM 140–239 codes 3 years before the surgery date). In total, 2426 qualified patients who had THR surgery were preliminarily retrieved after the exclusion filtering (Figure 1). To investigate the complications of THR patients with a COPD history, the study cohort was divided into COPD and non-COPD groups in which the COPD patients were identified by the diagnostic codes (ICD-9-CM 490–492, 496) within 2 years before the THR surgery from their inpatient and outpatient records.

View Article: PubMed Central - PubMed

ABSTRACT

Patients with chronic obstructive pulmonary disease (COPD) have a high risk of osteoporosis and fractures. The incidence rate of hip fracture has steadily increased over time and is a major common event in patients with osteoporosis and COPD. Total hip replacement (THR) is commonly performed in patients with hip fracture. Our aim was to compare the complications of THR between patients with and without COPD.

Longitudinally linked data from the National Health Insurance Research Database, which consists of registration, claims, and reimbursement records, for a cohort of 1,000,000 randomly selected enrollees traced retrospectively from 1996 to 2000 in Taiwan. Patients who had undergone THR surgery between January 1, 2004, and December 31, 2008, were identified and divided into COPD and non-COPD cohorts. Outcomes and complications, including 90-day mortality, 1-year mortality, 1-year wound infection, 30-day readmission for hospitalization, 30-day pneumonia, 30-day acute respiratory failure, 30-day cerebrovascular accident, and length of stay during hospitalization, were measured after THR.

The COPD group had a significantly higher ratio of complications, including 30-day readmission (14.0% vs 8.4%), 30-day pneumonia (10.4% vs 4.4%), 30-day acute respiratory failure (1.5% vs 0.5%), 1-year mortality (6.9% vs 2.7%), and length of stay in the hospital (10.6% vs 0.8%) than the non-COPD group.

In addition to airway diseases, patients in the COPD group had higher mortality than those in non-COPD group after THR. Surgeons should give more attention to airway evaluation and selection of patients with COPD for THR.

No MeSH data available.