medwireNews: People with spondyloarthritis (SpA) have higher healthcare needs and more complications, but lower mortality risk, after primary total hip or knee arthroplasty (THA or TKA) than those without the condition, show data from a large US cohort study.
Authors Jasvinder Singh and John Cleveland, both from the University of Alabama at Birmingham, believe that surgeons could use their findings “to inform patients during the consent process regarding the risks and complication rates.”
Singh and Cleveland identified 4,116,484 individuals undergoing THA and 8,127,282 undergoing TKA from the 1998–2014 US National Inpatient Sample. Of these, 1.7% and 1.0%, respectively, had SpA.
After adjustment for age, race/ethnicity, sex, income, comorbidity, insurance payer, and underlying diagnosis, the researchers found the people with SpA were significantly more likely than those without to need a blood transfusion, to have a hospital stay longer than the median of 3 days, and to be discharged to a care facility rather than home after undergoing THA, at odds ratios (ORs) of 1.16, 1.15, and 1.16, respectively.
Similar results were observed after TKA, with corresponding significant ORs of 1.10, 1.05, and 1.14.
The likelihood for implant infection post-TKA was also higher in people with SpA, at an OR of 3.02, but there was no significantly increased risk post-THA.
There was no difference between the people with versus without SpA for in-hospital revision rates for either surgery, but the investigators observed that people with SpA were significantly less likely to die while in hospital than those without SpA, at ORs of 0.78 and 0.40 following THA and TKA, respectively.
The SpA cohort was also less likely to have hospital charges above the median than the non-SpA cohort for both THA (OR=0.49) and TKA (OR=0.48).
Writing in Clinical Rheumatology Singh and Cleveland say: “Future studies need to examine interventions to reduce post-THA/TKA complications and optimize recovery from THA and TKA in people with SpA.”
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