Arthroplasty and IBD

Author

Kingery MT

Published

May 4, 2023

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Data summary
Name Piped data
Number of rows 264159
Number of columns 781
_______________________
Column type frequency:
factor 2
numeric 3
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Group variables None

Variable type: factor

skim_variable n_missing complete_rate ordered n_unique top_counts
disch_yr 0 1 FALSE 11 201: 29478, 201: 28147, 201: 27736, 201: 26506
gender_cd 3 1 FALSE 2 Fem: 146818, Mal: 117338

Variable type: numeric

skim_variable n_missing complete_rate mean sd p0 p25 p50 p75 p100 hist
age 0 1.00 64.93 11.76 10 57.00 65.00 73 106.00 ▁▁▇▆▁
length_of_stay 8671 0.97 2.98 2.63 1 2.00 3.00 3 280.00 ▇▁▁▁▁
followup 0 1.00 2.96 2.92 0 0.17 2.16 5 10.99 ▇▃▂▂▁
Data summary
Name Piped data
Number of rows 264159
Number of columns 781
_______________________
Column type frequency:
logical 6
________________________
Group variables ibd

Variable type: logical

skim_variable ibd n_missing complete_rate mean count
eventual_revision FALSE 0 1 0.02 FAL: 256385, TRU: 5619
eventual_revision TRUE 0 1 0.03 FAL: 2101, TRU: 54
any_rev_infection FALSE 0 1 0.01 FAL: 260092, TRU: 1912
any_rev_infection TRUE 0 1 0.01 FAL: 2140, TRU: 15
any_medical_complication FALSE 0 1 0.00 FAL: 261540, TRU: 464
any_medical_complication TRUE 0 1 0.00 FAL: 2151, TRU: 4
ed_visit_within_3months FALSE 0 1 0.09 FAL: 237123, TRU: 24881
ed_visit_within_3months TRUE 0 1 0.12 FAL: 1901, TRU: 254
readmission_within_3months FALSE 0 1 0.07 FAL: 244756, TRU: 17248
readmission_within_3months TRUE 0 1 0.09 FAL: 1956, TRU: 199
mortality_3months FALSE 0 1 0.00 FAL: 261209, TRU: 795
mortality_3months TRUE 0 1 0.00 FAL: 2146, TRU: 9

Methods

Summary of included patients

Initial data query yielded a total of 332,638 cases in 281,988 patients. Revision cases where the corresponding primary case was not found in the database (e.g., because the primary occurred prior to the study period or outside of New York state) were excluded (10,721 in 8,418 patients). Additional cases with illogical or inconsistent data, likely to be the result of medical coding errors, were removed as necessary (e.g., patients greater than 2 primary cases or more than 1 primary case of the same laterality). For the purposes of this analysis, hemiarthroplasty cases were excluded (48,612 cases).

Results

Demographics

Table 1: Patient demographics for all patients who underwent THA during the study period.
Characteristic Overall, N = 228,4391 IBD p-value2
IBD, N = 1,8781 No IBD, N = 226,5611
Indication <0.001
    OA 137,904 (60.4%) 1,018 (54.2%) 136,886 (60.4%)
    Fracture 17,551 (7.7%) 219 (11.7%) 17,332 (7.7%)
    AVN 12,142 (5.3%) 180 (9.6%) 11,962 (5.3%)
    Inflammatory arthritis 5,589 (2.4%) 83 (4.4%) 5,506 (2.4%)
    Unspecified 55,253 (24.2%) 378 (20.1%) 54,875 (24.2%)
Age (years) 65.0 +/- 11.9 64.6 +/- 12.3 65.0 +/- 11.8 0.163
Sex <0.001
    Female 126,600 (55.4%) 1,135 (60.4%) 125,465 (55.4%)
    Male 101,836 (44.6%) 743 (39.6%) 101,093 (44.6%)
Race <0.001
    White 185,521 (81.2%) 1,671 (89.0%) 183,850 (81.1%)
    Black 17,167 (7.5%) 73 (3.9%) 17,094 (7.5%)
    Hispanic 10,698 (4.7%) 57 (3.0%) 10,641 (4.7%)
    Asian 2,192 (1.0%) 9 (0.5%) 2,183 (1.0%)
    Native American 429 (0.2%) 4 (0.2%) 425 (0.2%)
    Other or Unknown 12,432 (5.4%) 64 (3.4%) 12,368 (5.5%)
Elixhauser score 1.0 +/- 4.7 1.6 +/- 5.3 1.0 +/- 4.6 <0.001
Insurance <0.001
    Private 112,002 (49.0%) 868 (46.2%) 111,134 (49.1%)
    Medicare 103,189 (45.2%) 936 (49.8%) 102,253 (45.1%)
    Medicaid 7,120 (3.1%) 34 (1.8%) 7,086 (3.1%)
    Worker's Compensation 3,312 (1.4%) 19 (1.0%) 3,293 (1.5%)
    Other 2,814 (1.2%) 21 (1.1%) 2,793 (1.2%)
Follow-up duration (years) 3.0 +/- 3.0 3.2 +/- 2.9 3.0 +/- 3.0 0.015
1 n (%); Mean +/- SD
2 Pearson’s Chi-squared test; Welch Two Sample t-test; Fisher’s Exact Test for Count Data with simulated p-value (based on 2000 replicates)
Table 2: Patient demographics for patients who underwent THA with at least 2 years of postoperative follow-up.
Characteristic Overall, N = 118,9471 IBD p-value2
IBD, N = 1,0341 No IBD, N = 117,9131
Indication <0.001
    OA 57,733 (48.5%) 480 (46.4%) 57,253 (48.6%)
    Fracture 6,655 (5.6%) 90 (8.7%) 6,565 (5.6%)
    AVN 6,612 (5.6%) 105 (10.2%) 6,507 (5.5%)
    Inflammatory arthritis 3,150 (2.6%) 44 (4.3%) 3,106 (2.6%)
    Unspecified 44,797 (37.7%) 315 (30.5%) 44,482 (37.7%)
Age (years) 65.3 +/- 11.7 64.7 +/- 12.2 65.3 +/- 11.7 0.146
Sex 0.016
    Female 67,619 (56.8%) 626 (60.5%) 66,993 (56.8%)
    Male 51,328 (43.2%) 408 (39.5%) 50,920 (43.2%)
Race <0.001
    White 97,602 (82.1%) 924 (89.4%) 96,678 (82.0%)
    Black 8,805 (7.4%) 36 (3.5%) 8,769 (7.4%)
    Hispanic 5,458 (4.6%) 32 (3.1%) 5,426 (4.6%)
    Asian 720 (0.6%) 5 (0.5%) 715 (0.6%)
    Native American 199 (0.2%) 2 (0.2%) 197 (0.2%)
    Other or Unknown 6,163 (5.2%) 35 (3.4%) 6,128 (5.2%)
Elixhauser score 1.0 +/- 4.5 1.5 +/- 4.9 1.0 +/- 4.4 0.004
Insurance 0.004
    Private 57,248 (48.1%) 446 (43.1%) 56,802 (48.2%)
    Medicare 55,495 (46.7%) 541 (52.3%) 54,954 (46.6%)
    Medicaid 3,184 (2.7%) 21 (2.0%) 3,163 (2.7%)
    Worker's Compensation 1,692 (1.4%) 12 (1.2%) 1,680 (1.4%)
    Other 1,326 (1.1%) 14 (1.4%) 1,312 (1.1%)
Follow-up duration (years) 5.4 +/- 2.3 5.3 +/- 2.3 5.4 +/- 2.3 0.477
1 n (%); Mean +/- SD
2 Pearson’s Chi-squared test; Welch Two Sample t-test; Fisher’s Exact Test for Count Data with simulated p-value (based on 2000 replicates)

Outcomes

Table 3: Outcomes following THA for cases with ≥ 2 years postoperative follow-up.
Characteristic IBD p-value2
IBD, N = 1,1651 No IBD, N = 133,6361
Length of hospital stay (days) 3.5 +/- 2.3 3.2 +/- 2.3 <0.001
ED presentation within 3 months 157 (13.5%) 14,811 (11.1%) 0.010
Readmission within 3 months 123 (10.6%) 10,258 (7.7%) <0.001
Readmission within 12 months 202 (17.3%) 17,049 (12.8%) <0.001
All-cause revision 42 (3.6%) 3,814 (2.9%) 0.126
Revision for PJI 9 (0.8%) 1,240 (0.9%) 0.582
Time to first revision (years) 3.5 +/- 2.7 2.9 +/- 2.7 0.153
Reoperation within 3 months of primary 9 (0.8%) 833 (0.6%) 0.520
Reoperation within 12 months of primary 12 (1.0%) 1,300 (1.0%) 0.843
1 Mean +/- SD; n (%)
2 Wilcoxon rank sum test; Pearson’s Chi-squared test
Table 4: Perioperative outcomes following THA for all patients
Characteristic IBD p-value2
IBD, N = 2,1551 No IBD, N = 262,0041
ED presentation within 3 months 254 (11.8%) 24,881 (9.5%) <0.001
Readmission within 3 months 199 (9.2%) 17,248 (6.6%) <0.001
Readmission within 12 months 327 (15.2%) 28,001 (10.7%) <0.001
Mortality within 3 months 9 (0.4%) 795 (0.3%) 0.338
Mortality within 12 months 15 (0.7%) 1,597 (0.6%) 0.608
1 n (%)
2 Pearson’s Chi-squared test

Survival analysis

Figure 1: Survival and hazard curves for primary THA

Figure 2: Survival and hazard curves for primary THA

GLM for risk of revision

Table 5: Logistic regression models demonstrating the odds of all-cause revision (a) and revision for PJI (b) for patients undergoing THA with at least 2 years of follow-up. Patients with IBD did not have an increased risk of all-cause revision or infection-related revision compared to patients without IBD.

(a)
Odds of all-cause revision
Characteristic OR1 95% CI1 p-value
IBD
    No IBD — —
    IBD 1.20 0.87, 1.62 0.244
Age (years) 0.99 0.98, 0.99 <0.001
Sex
    Female — —
    Male 0.95 0.89, 1.01 0.112
Elixhauser score 1.00 1.00, 1.01 0.467
Operative indication
    OA — —
    Fracture 1.65 1.45, 1.87 <0.001
    Inflammatory arthritis 1.62 1.37, 1.89 <0.001
    AVN 1.22 1.07, 1.39 0.003
    Unspecified 0.90 0.83, 0.97 0.004
Obesity
    No — —
    Yes 1.13 1.04, 1.22 0.003
DM
    No — —
    Yes 1.01 0.91, 1.11 0.915
Length of hospital stay (days) 1.02 1.01, 1.03 <0.001
1 OR = Odds Ratio, CI = Confidence Interval
(b)
Odds of revision for PJI
Characteristic OR1 95% CI1 p-value
IBD
    No IBD — —
    IBD 0.79 0.38, 1.43 0.474
Age (years) 0.98 0.97, 0.98 <0.001
Sex
    Female — —
    Male 1.22 1.09, 1.37 <0.001
Elixhauser score 1.02 1.01, 1.03 0.002
Operative indication
    OA — —
    Fracture 1.75 1.39, 2.19 <0.001
    Inflammatory arthritis 1.95 1.48, 2.54 <0.001
    AVN 1.51 1.22, 1.86 <0.001
    Unspecified 1.02 0.90, 1.16 0.781
Obesity
    No — —
    Yes 1.64 1.44, 1.87 <0.001
DM
    No — —
    Yes 1.22 1.04, 1.42 0.012
Length of hospital stay (days) 1.02 1.01, 1.03 <0.001
1 OR = Odds Ratio, CI = Confidence Interval