Lupus Linked to Poor Outcomes Post-Primary Total Hip Arthroplasty

Individuals with systemic lupus erythematosus (SLE) who have primary total hip arthroplasty (THA) are at higher risk for implant infection, discharge to an inpatient facility, more expensive hospital bills, and increased blood transfusions than people without SLE, according to a study recently published in Lupus.

This retrospective study included 4,116,485 US hospitalizations for primary THA between 1998 and 2014. Of these, 0.5% (n=22,557) had SLE. Separate logistic regression models were used to examine the relationship between SLE and adverse postoperative events (transfusion, THA revision, implant infection, and mortality) and utilization of health care (hospital length of stay >3 days, discharge to inpatient facility, and total hospital charges).

Using odds ratios (ORs) with 95% confidence intervals (CI), adjustments were made for underlying diagnosis, insurance payer, hospital characteristics, comorbidity, and demographics. A separate logistic regression was performed for each outcome, which included SLE and any relevant confounders and covariates.

Having lupus was associated with younger age, being Hispanic or black, having Medicaid insurance, lower income, higher comorbidity, and living in the South. Multivariable-adjusted analysis showed an association with SLE and higher risk for postoperative implant infection (OR, 1.95; 95% CI, 1.28-2.97), transfusion (OR, 1.34; 95% CI, 1.25-1.43), inpatient facility discharge (OR, 1.38; 95% CI, 1.30-1.47), and increased hospital bills above median (OR, 1.21; 95% CI, 1.01-1.44).

However, SLE did not show a significant association with the risk for mortality (OR, 0.95; 95% CI, 0.61-1.47), revision (OR, 1.10; 95% CI, 0.68-1.78), or length of hospital stay (OR, 1.06; 95% CI, 0.99-1.13). These results were not significantly altered in sensitivity analyses.

Limitations to this study include the use of single-center studies, small sample sizes, and the combination of postoperative complications taken together.

The study researchers concluded that “SLE was independently associated with a higher risk of implant infection, transfusion and healthcare utilization post-THA during the index hospitalization. SLE was not associated with a higher risk of in-patient implant revision or mortality. A small increase in healthcare utilization in patients with SLE in our study, coupled with significant gains in pain, function and quality of life with primary THA, provides justification for performing THA in patients with SLE. Our study findings should prompt total joint registry studies to investigate the causes of implant infection, transfusion and higher hospital charges in patients with SLE undergoing primary THA.”

Disclosure: Jasvinder A Singh, MD, MPH, has received consultant fees from Crealta/Horizon, Fidia, and UBM LLC. He also owns stock options in Amarin pharmaceuticals and Viking therapeutics.

Reference

Singh JA, Cleveland JD. Lupus is associated with poorer outcomes after primary total hip arthroplasty. Lupus. 2019;28(7):834-842.