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. 2022 Dec 14:19:101015.
doi: 10.1016/j.artd.2022.08.008. eCollection 2023 Feb.

Incidence, Risk Factors, and Subsequent Complications of Postoperative Hematomas Requiring Reoperation After Primary Total Hip Arthroplasty

Neil Pathak  1 , Pat Bovonratwet  2 , James J Purtill  3 , Jenna A Bernstein  1 , Marjorie Golden  4 , Jonathan N Grauer  1 , Lee E Rubin  1
Affiliations

Incidence, Risk Factors, and Subsequent Complications of Postoperative Hematomas Requiring Reoperation After Primary Total Hip Arthroplasty

Neil Pathak et al. Arthroplast Today. .

Abstract

Background: Studies analyzing the incidence and clinical implications of postoperative hematomas after total hip arthroplasty (THA) remain limited. The purpose of the present study was to use the National Surgical Quality Improvement Program (NSQIP) dataset to determine rates, risk factors, and subsequent complications of postoperative hematomas requiring reoperation after primary THA.

Methods: Study population included patients who underwent primary THA (CPT code: 27130) from 2012-2016 recorded in NSQIP. Patients who developed a hematoma requiring reoperation in the 30-day postoperative period were identified. Multivariate regressions were created to identify patient characteristics, operative variables, and subsequent complications that were associated with a postoperative hematoma requiring reoperation.

Results: Among the 149,026 patients who underwent primary THA, 180 (0.12%) developed a postoperative hematoma requiring reoperation. Risk factors included body mass index (BMI) ≥ 35 (relative risk [RR]: 1.83, P = .011), American Society of Anesthesiologists (ASA) class ≥3 (RR: 2.11, P < .001), and history of bleeding disorder (RR: 2.71, P < .001). Associated intraoperative characteristics were an operative time ≥100 minutes (RR: 2.03, P < .001) and use of general anesthesia (RR: 1.41, P = .028). Patients developing a hematoma requiring reoperation were at higher risk of subsequent deep wound infection (RR: 21.57, P < .001), sepsis (RR: 4.3, P = .012), and pneumonia (RR: 3.69, P = .023).

Conclusions: Surgical evacuation for a postoperative hematoma was performed in about 1 in 833 cases of primary THA. Several nonmodifiable and modifiable risk factors were identified. Given the 21.6 times increased risk of subsequent deep wound infection, select, at-risk patients may benefit from closer monitoring for signs of infection.

Keywords: Arthroplasty; NSQIP; Postoperative hematoma; Primary hip arthroplasty; Surgical outcomes.

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Figures

Figure 1
Figure 1
Timing of diagnoses. Percentages of postoperative hematomas requiring reoperation that occurred during the index hospitalization and after index hospitalization are represented.
Figure 2
Figure 2
Depiction of adverse events listed at the left, and diamonds central to the horizontal lines indicate relative risks. Horizontal lines denote the 95% confidence intervals of those relative risks. Vertical line is defined as a relative risk (RR) of 1. Thus, horizontal lines that cross the vertical line specify relative risks that were not found to be statistically significant. Black lines and bolding specify relative risks that are statistically significant.
See this image and copyright information in PMC

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