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The Journal of Hip Surgery 2019; 03(02): 062-067
DOI: 10.1055/s-0039-1678748
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Hypothyroidism Increases 90-Day Complications and Cost Following Primary Total Hip Arthroplasty

Dhanur Damodar
1   Department of Orthopedic Surgery, University of Miami, Miami, Florida
,
Ajit Vakharia
2   Department of Orthopedic Surgery, Morehouse School of Medicine, Atlanta, Georgia
,
Erik Zachwieja
1   Department of Orthopedic Surgery, University of Miami, Miami, Florida
,
Rushabh Vakharia
3   Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, Florida
,
Victor Hernandez
1   Department of Orthopedic Surgery, University of Miami, Miami, Florida
,
Martin W. Roche
3   Orthopedic Research Institute, Holy Cross Hospital, Ft. Lauderdale, Florida
› Author Affiliations
Further Information

Publication History

23 July 2018

19 November 2018

Publication Date:
01 March 2019 (online)

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Abstract

Hypothyroidism is common, and the incidence has been increasing annually in the United States. Abnormalities in thyroid hormone can have several effects on the endocrine, immune, and musculoskeletal systems of the body. The influence of hypothyroidism on outcomes following primary total hip arthroplasty (THA) is not well reported. The authors hypothesized that hypothyroidism was associated with a higher risk of postoperative complications and 90-day costs following primary THA. A retrospective review from 2005 to 2014 was performed using the Medicare Standard Analytical Files from the Pearl Diver database. Utilizing International Classification of Disease 9th revision (ICD-9) codes, the authors identified patients who underwent THA. Patients with a concurrent diagnosis of hypothyroidism were matched by age, gender, and Charlson's comorbidity index (CCI) to a control group. Ninety-day postoperative complications, readmission rates, complications related to implants, and cost of care were compared and assessed following primary THA between matched cohorts. Statistical analysis was performed using the programming language R (University of Auckland) to calculate odds ratios (OR) along with their respective 95% confidence intervals (95% CI), and p-values. A total of 383,898 patients underwent primary THA. Among them, 191,949 patients were diagnosed with hypothyroidism and 191,949 patients without hypothyroidism. Hypothyroidism was associated with greater odds of postoperative complications (p < 0.001), 90-day readmission rates (p < 0.001), implant related complications (p < 0.001), and total global 90-day episode of care cost (U.S. $17,549.96 vs. $16,645.01; p < 0.001). This study demonstrated an increased risk of postoperative complications (medical or implant related), increased readmission rates, and higher costs among patients with hypothyroidism following primary THA. Surgeons should counsel patients and determine strategies to medically optimize patients to mitigate risk and decrease cost.

Keywords

total hip arthroplasty outcomes - Medicare - complications - hypothyroidism - database
 

  • References

  • 1 Wukich DK. Diabetes and its negative impact on outcomes in orthopaedic surgery. World J Orthop 2015; 6 (03) 331-339
    CrossrefPubMedGoogle Scholar
  • 2 Akiboye F, Rayman G. Management of hyperglycemia and diabetes in orthopedic surgery. Curr Diab Rep 2017; 17 (02) 13
    CrossrefPubMedGoogle Scholar
  • 3 Kim YA, Park YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab (Seoul) 2014; 29 (01) 20-29
    PubMedGoogle Scholar
  • 4 Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017; 390 (10101): 1550-1562
    CrossrefPubMedGoogle Scholar
  • 5 Tan TL, Rajeswaran H, Haddad S, Shahi A, Parvizi J. Increased risk of periprosthetic joint infections in patients with hypothyroidism undergoing total joint arthroplasty. J Arthroplasty 2016; 31 (04) 868-871
    CrossrefPubMedGoogle Scholar
  • 6 Buller LT, Rosas S, Sabeh KG, Roche MW, McLawhorn AS, Barsoum WK. Hypothyroidism increases 90-day complications and costs following primary total knee arthroplasty. J Arthroplasty 2018; 33 (04) 1003-1007
    CrossrefPubMedGoogle Scholar
  • 7 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 8 Kyriacou A, McLaughlin J, Syed AA. Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review. Eur J Intern Med 2015; 26 (08) 563-571
    CrossrefPubMedGoogle Scholar
  • 9 Lencu C, Alexescu T, Petrulea M, Lencu M. Respiratory manifestations in endocrine diseases. Clujul Med 2016; 89 (04) 459-463
    PubMedGoogle Scholar
  • 10 Sadek SH, Khalifa WA, Azoz AM. Pulmonary consequences of hypothyroidism. Ann Thorac Med 2017; 12 (03) 204-208
    CrossrefPubMedGoogle Scholar
  • 11 Ioachimescu AG, Makdissi A, Lichtin A, Zimmerman RS. Thyroid disease in patients with idiopathic thrombocytopenia: a cohort study. Thyroid 2007; 17 (11) 1137-1142
    CrossrefPubMedGoogle Scholar
  • 12 Yaylali O, Kirac S, Yilmaz M. , et al. Does hypothyroidism affect gastrointestinal motility?. Gastroenterol Res Pract 2009; 2009: 529802
    PubMedGoogle Scholar
  • 13 Ling XW, Howe TS, Koh JSB, Wong MK, Ng ACM. Preoperative thyroid dysfunction predicts 30-day postoperative complications in elderly patients with hip fracture. Geriatr Orthop Surg Rehabil 2013; 4 (02) 43-49
    CrossrefPubMedGoogle Scholar
  • 14 Daher R, Yazbeck T, Jaoude JB, Abboud B. Consequences of dysthyroidism on the digestive tract and viscera. World J Gastroenterol 2009; 15 (23) 2834-2838
    CrossrefPubMedGoogle Scholar
  • 15 Gunsar F, Yilmaz S, Bor S. , et al. Effect of hypo- and hyperthyroidism on gastric myoelectrical activity. Dig Dis Sci 2003; 48 (04) 706-712
    CrossrefPubMedGoogle Scholar
  • 16 Bassi R, Dhillon S, Sharma S, Sharma S, Tapdiya M. Effect of thyroid hormone replacement on respiratory function tests in hypothyroid women. Pakistan J Physiol 2012; 8 (02) 20-23
    PubMedGoogle Scholar
  • 17 Lim S-J, Yeo I, Park C-W, Moon Y-W, Park Y-S. Outcomes of total hip arthroplasty in patients with primary immune thrombocytopenia. BMC Musculoskelet Disord 2015; 16: 278
    CrossrefPubMedGoogle Scholar
  • 18 Bozic KJ, Lau E, Kurtz S. , et al. Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients. J Bone Joint Surg Am 2012; 94 (09) 794-800
    CrossrefPubMedGoogle Scholar
  • 19 De Vito P, Balducci V, Leone S. , et al. Nongenomic effects of thyroid hormones on the immune system cells: new targets, old players. Steroids 2012; 77 (10) 988-995
    CrossrefPubMedGoogle Scholar
  • 20 De Vito P, Incerpi S, Pedersen JZ, Luly P, Davis FB, Davis PJ. Thyroid hormones as modulators of immune activities at the cellular level. Thyroid 2011; 21 (08) 879-890
    CrossrefPubMedGoogle Scholar
  • 21 Frick LR, Rapanelli M, Bussmann UA. , et al. Involvement of thyroid hormones in the alterations of T-cell immunity and tumor progression induced by chronic stress. Biol Psychiatry 2009; 65 (11) 935-942
    CrossrefPubMedGoogle Scholar
  • 22 Kosińska A, Syrenicz A, Kosiński B, Garanty-Bogacka B, Syrenicz M, Gromniak E. [Osteoporosis in thyroid diseases]. Endokrynol Pol 2005; 56 (02) 185-193
    PubMedGoogle Scholar
  • 23 Williams GR. Actions of thyroid hormones in bone. Endokrynol Pol 2009; 60 (05) 380-388
    PubMedGoogle Scholar
  • 24 Vestergaard P, Weeke J, Hoeck HC. , et al. Fractures in patients with primary idiopathic hypothyroidism. Thyroid 2000; 10 (04) 335-340
    CrossrefPubMedGoogle Scholar
  • 25 Lee JS, Buzková P, Fink HA. , et al. Subclinical thyroid dysfunction and incident hip fracture in older adults. Arch Intern Med 2010; 170 (21) 1876-1883
    PubMedGoogle Scholar
  • 26 Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R. The cost of treating community-acquired pneumonia. Clin Ther 1998; 20 (04) 820-837
    CrossrefPubMedGoogle Scholar
  • 27 Fanikos J, Rao A, Seger AC, Carter D, Piazza G, Goldhaber SZ. Hospital costs of acute pulmonary embolism. Am J Med 2013; 126 (02) 127-132
    CrossrefPubMedGoogle Scholar
  • 28 Dasta JF, Pilon D, Mody SH. , et al. Daily hospitalization costs in patients with deep vein thrombosis or pulmonary embolism treated with anticoagulant therapy. Thromb Res 2015; 135 (02) 303-310
    CrossrefPubMedGoogle Scholar
  • 29 Carter Clement R, Bhat SB, Clement ME, Krieg JC. Medicare reimbursement and orthopedic surgery: past, present, and future. Curr Rev Musculoskelet Med 2017; 10 (02) 224-232
    CrossrefPubMedGoogle Scholar
  • 30 Hogan CA, Sandoval MF, Uhler LM. Centers for Medicare & Medicaid services' comprehensive care for joint replacement: the present and future for orthopedic surgeons. Orthopedics 2017; 40 (02) 77-80
    CrossrefPubMedGoogle Scholar
  • 31 Cancienne JM, Dempsey IJ, Holzgrefe RE, Brockmeier SF, Werner BC. Is hepatitis C infection associated with a higher risk of complications after total shoulder arthroplasty?. Clin Orthop Relat Res 2016; 474 (12) 2664-2669
    CrossrefPubMedGoogle Scholar
  • 32 Burrus MT, Werner BC, Cancienne JM, Gwathmey FW, Brockmeier SF. Shoulder arthroplasty in patients with Parkinson's disease is associated with increased complications. J Shoulder Elbow Surg 2015; 24 (12) 1881-1887
    CrossrefPubMedGoogle Scholar
  • 33 Singh JA, Lewallen DG. Increasing obesity and comorbidity in patients undergoing primary total hip arthroplasty in the U.S.: a 13-year study of time trends. BMC Musculoskelet Disord 2014; 15: 441
    CrossrefPubMedGoogle Scholar