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. 2009 Jun;33(3):643-51.
doi: 10.1007/s00264-008-0549-4. Epub 2008 May 7.

Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States

Spencer S Liu  1 , Alejandro González Della Valle, Melanie C Besculides, Licia K Gaber, Stavros G Memtsoudis
Affiliations

Trends in mortality, complications, and demographics for primary hip arthroplasty in the United States

Spencer S Liu et al. Int Orthop. 2009 Jun.

Abstract
in English, French

To determine trends in characteristics of total hip arthroplasty (THA) in the United States, the National Hospital Discharge Survey (NHDS) was analyzed from 1990 to 2004 for trends in in-hospital mortality and complications, length of hospital stay, demographics, and comorbidities. The number of THAs performed increased by 158%, whereas mortality rates remained low and slightly decreased (from 0.32% to 0.29%). Prevalence of procedure-related complications decreased over time, and length of stay decreased from an average of 8.7 days to 4.5 days. These improvements occurred despite an increase in comorbidities in patients. An increase in both the proportion of discharges to long- and short-term care facilities and in the proportion of procedures performed in smaller hospitals was noted. Multiple temporal changes in outcomes and demographics for THA were found. These changes have implications for clinical care and allocation of health resources.

Le but de ce travail est de mettre en évidence les nouvelles données caractéristiques des prothèses totales de hanche aux Etats-Unis. Matériel et méthode: Le National Hospital Discharge Survey (NHDS) a été analysé durant la période de 1990 à 2004 sur le plan de la mortalité, des complications, de la durée de séjour, sur le plan démographique et des comorbidités. Résultat: le nombre de prothèses totales de hanche a augmenté de 158% dans cette période alors que la mortalité reste basse et a même légèrement diminué (0,32% à 0,29%). Le taux de complications et la durée moyenne de séjour diminuent également avec le temps de 8,7 jours à 4,5 jours. Ces améliorations entraînent néanmoins une augmentation des comorbidités chez les patients. Il a été noté une augmentation de la proportion des sorties avec prise en charge des soins de courte ou longue durée et une proportion importante de procédures réalisées dans les petits hôpitaux. les modifications notées sur le devenir et sur les bases démographiques des prothèses totales de hanche, ont une implication clinique sur les soins et sur l’allocation de ressource.

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Figures

Fig. 1
Fig. 1
a Use of primary total hip arthroplasty in the three study periods expressed as number of total hip arthroplasties performed per 100,000 civilians. The figures show total implantation and age-group adjusted implantation per each 5-year study period. Age adjusted implantations are restricted to the stated age group. Significant differences (P < 0.001) between all time periods for age groups 46–65 and 65–84. Significant differences (P <0.001) for total implantation for 1990–1994 and 2000–2004 only. b Age group adjusted percent change of implantation of primary total hip arthroplasties over time for each 5-year study period. Age adjusted implantations are restricted to the stated age group
Fig. 2
Fig. 2
Discharge disposition as percent of all discharges (%) (left y-axis) and average hospital stay (days) (right y-axis) over time. Note that total percent of discharge dispositions may not add up to 100% as only selected disposition options are shown. Significant differences (P < 0.001) for all discharge destinations between all time periods, except for “long-term care facility” between 1995–1999 and 2000–2004. Significant differences (P < 0.001) for average hospital stay between all time periods
Fig. 3
Fig. 3
Distribution of procedure volume by hospital bed size from 1990 to 2004. Significant differences (P < 0.001) for all hospital sizes between all time periods, except for 500+ between 1990–1994 and 2000–2004
Fig. 4
Fig. 4
Use of primary total hip arthroplasty for total population and restricted to either male or female gender for each 5-year study period. P < 0.001 for total and gender adjusted use between 1990–1994 and 2000–2004 (both genders)
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