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

Abstract

ObjectiveTo 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.DesignSystematic review and meta-analysis.MethodsMedline, 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.OutcomesThe 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.Results70 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.ConclusionsThis 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.

Impact of chronic kidney disease on outcomes after total joint arthroplasty: A meta-analysis & systematic review.

“…Comorbidities in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are known to result in poor outcomes with longer hospital stays, increased hospital readmission rates and higher mortality rates [1]. Comorbidities previously reported for poor surgical outcomes in the setting of joint replacement surgery include obesity [2], cardiovascular disease [3], depression and other mental health disorders [4][5][6], diabetes mellitus [7][8][9], hepatic disease [10][11][12], and frailty [13].…”

“…Studies on joint replacement also show variations in the definitions and severity of comorbid disease [1], which may yield conflicting results, and consensus is still lacking among clinicians about the clinical indications for joint replacement surgeries [14], which may lead to differences in outcomes based on severity levels of associated comorbidities.…”

“…Although the medical literature has focused increasingly on the potential impact of CKD and various postoperative outcomes, no comprehensive systematic review and meta-analysis has yet been published. In addition, given that interest in elective TJA is growing and the volume of these surgeries is rising correspondingly [22], orthopedic surgeons need to recognize the healthcare burden of this population and must assess outcomes of TJA in patients with CKD or other comorbid conditions in order to optimize treatment strategies and improve outcomes [1].…”

What Has Changed in the Structure of Revision Hip Arthroplasty?

“…При том, что в целом десятилетняя выживаемость после первичного ТЭП ТБС весьма впечатляющая -95-97%*. Для определенных групп пациентов (очень молодые пациенты, пациенты с парами трения металл-металл, пациенты со сложной патологией, выраженной коморбидностью и прочие) эти показатели могут быть существенно хуже и снижаться до 70-80% в те же сроки [5,13,14,15,16,17,18,19,20], а результаты ревизий, и тем более повторных ревизий, вообще в отчетах регистров либо не представлены, либо отражены очень поверхностно [12,21,22]. ТРАВМАТОЛОГИЯ В свою очередь, исследования, посвященные оценке эффективности ревизионных операций, указывают на невозможность достичь такого же уровня успеха, как при первичном эндопротезировании [23,24,25].…”

Postoperative Complications Causing Readmission in 30 Days after Total Knee Arthroplasty: A Retrospective Nested Case-Control Study of Risk Factors Based on Propensity Score Matching

“…Patient comorbidities, 13 such as diabetes mellitus (DM), 14 previous cerebrovascular accident (CVA), or transient ischemic attack (TIA), 15 have also been proven to increase the risk of surgery failure due to infection or DVT after TKA; this results in postoperative complications and readmission within 30 days for further treatment. 8,16 In addition, some preoperative details can also negatively influence postoperative recovery. 17 For example, Leijtens et al 18 confirmed the correlation between perioperative bridging of anticoagulant therapy and high complication rate after total hip replacement (THR) and TKA.…”