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Meta-Analysis
. 2018 Jul 11;8(7):e021784.
doi: 10.1136/bmjopen-2018-021784.

Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis

Bélène Podmore  1   2 , Andrew Hutchings  1   2 , Jan van der Meulen  1   2 , Ajay Aggarwal  1   2 , Sujith Konan  3
Affiliations
Meta-Analysis

Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis

Bélène Podmore et al. BMJ Open. .

Abstract

Objective: To systematically perform a meta-analysis of the association between different comorbid conditions on safety (short-term outcomes) and effectiveness (long-term outcomes) in patients undergoing hip and knee replacement surgery.

Design: Systematic review and meta-analysis.

Methods: Medline, Embase and CINAHL Plus were searched up to May 2017. We included all studies that reported data to allow the calculation of a pooled OR for the impact of 11 comorbid conditions on 10 outcomes (including surgical complications, readmissions, mortality, function, health-related quality of life, pain and revision surgery). The quality of included studies was assessed using a modified Newcastle-Ottawa Scale. Continuous outcomes were converted to ORs using the Hasselblad and Hedges approach. Results were combined using a random-effects meta-analysis.

Outcomes: The primary outcome was the adjusted OR for the impact of each 11 comorbid condition on each of the 10 outcomes compared with patients without the comorbid condition. Where the adjusted OR was not available the secondary outcome was the crude OR.

Results: 70 studies were included with 16 (23%) reporting on at least 100 000 patients and 9 (13%) were of high quality. We found that comorbidities increased the short-term risk of hospital readmissions (8 of 11 conditions) and mortality (8 of 11 conditions). The impact on surgical complications was inconsistent across comorbid conditions. In the long term, comorbid conditions increased the risk of revision surgery (6 of 11 conditions) and long-term mortality (7 of 11 conditions). The long-term impact on function, quality of life and pain varied across comorbid conditions.

Conclusions: This systematic review shows that comorbidities predominantly have an impact on the safety of hip and knee replacement surgery but little impact on its effectiveness. There is a need for high-quality studies also considering the severity of comorbid conditions.

Keywords: comorbidity; hip; knee; outcomes; systematic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
Forest plots of short-term outcomes.
Figure 3
Figure 3
Forest plots of long-term outcomes.
Figure 4
Figure 4
Funnel plot showing 95% confidence limits for any surgical complications, surgical site infections, venous thromboembolism, readmissions to hospital and pain in patients with diabetes.
Figure 5
Figure 5
Funnel plot showing 95% confidence limits for any surgical site infections, readmissions to hospital, short-term mortality and long-term mortality in patients with kidney disease.
See this image and copyright information in PMC

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