This Article Full Text Full Text (PDF) CME: Take the exams for this article: CME 1: January, February, March 2007 (publication date April 5, 2007; expir... Adult Hip Reconstruction Test 24: Spring 2007 (publication date May 15, 200... [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zhan, C. Articles by Bright, R. A. Search for Related Content PubMed Articles by Zhan, C. Articles by Bright, R. A. Related Collections Adult Hip Social Bookmarking             What's this?

Incidence and Short-Term Outcomes of Primary and Revision Hip Replacement in the United States

¹ Centers for Outcomes and Evidence (C.Z.) and Quality Improvement and Patient Safety (J.S.), Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. E-mail address for C. Zhan: chunliu.zhan{at}ahrq.hhs.gov. E-mail address for J. Sangl: judith.sangl{at}ahrq.hhs.gov
² Epidemiology Branch, Division of Postmarket Surveillance, Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, 1350 Piccard Drive, HFZ-541, Rockville, MD 20850. E-mail address for R. Kaczmarek: rxk{at}cdrh.fda.gov. E-mail address for N. Loyo-Berrios: nlb{at}cdrh.fda.gov. E-mail address for R.A. Bright: rxb{at}cdrh.fda.gov

Investigation performed at the Agency for Healthcare Research and Quality, Rockville, Maryland

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality, the Food and Drug Administration, or the United States Department of Health and Human Services.

Methods: We screened more than eight million hospital discharge abstracts from the 2003 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and approximately nine million discharge abstracts from five state inpatient databases. Patients who had undergone total, partial, or revision hip replacement were identified with use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes. In-hospital mortality, perioperative complications, readmissions, and the association between these outcomes and certain patient and hospital variables were analyzed.

Results: Approximately 200,000 total hip replacements, 100,000 partial hip replacements, and 36,000 revision hip replacements were performed in the United States in 2003. Approximately 60% of the patients were sixty-five years of age or older and at least 75% had one or more comorbid diseases. The in-hospital mortality rates associated with these three procedures were 0.33%, 3.04%, and 0.84%, respectively. The perioperative complication rates associated with the three procedures were 0.68%, 1.36%, and 1.08%, respectively, for deep vein thrombosis or pulmonary embolism; 0.28%, 1.88%, and 1.27% for decubitus ulcer; and 0.05%, 0.06%, and 0.25% for postoperative infection. The rates of readmission, for any cause, within thirty days were 4.91%, 12.15%, and 8.48%, respectively, and the rates of readmissions, within thirty days, that resulted in a surgical procedure on the affected hip were 0.79%, 0.91%, and 1.53%. The rates of readmission, for any cause, within ninety days were 8.94%, 21.14%, and 15.72%, and the rates of readmissions, within ninety days, that resulted in a surgical procedure on the affected hip were 2.15%, 1.61%, and 3.99%. Advanced age and comorbid diseases were associated with worse outcomes, while private insurance coverage and planned admissions were associated with better outcomes. No consistent association between outcomes and hospital characteristics, such as hip procedure volume, was identified.

Conclusions: Total hip replacement, partial hip replacement, and revision hip replacement are associated with different rates of postoperative complications and readmissions. Advanced age, comorbidities, and nonelective admissions are associated with inferior outcomes.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				M. H. Huo, N. F. Gilbert, and J. Parvizi What's New in Total Hip Arthroplasty J. Bone Joint Surg. Am., August 1, 2007; 89(8): 1874 - 1885. [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.