In-Hospital Complications and Readmission in Patients with Hemophilia Undergoing Hip or Knee Arthroplasty

Abstract

Background: Individuals with hemophilia undergoing hip or knee arthroplasty are at risk for complications such as bleeding and infection. However, data on hospital length of stay (LOS) and readmission rates compared with nonhemophilic controls are lacking. This study compared the complication rates, LOS, and unplanned 30-day readmission rates between patients with hemophilia and nonhemophilic controls. Methods: This retrospective cohort study used the Pennsylvania Health Care Cost Containment Council (PHC4) database from 2007 to 2015 to compare outcomes in patients with hemophilia and nonhemophilic controls undergoing partial and total hip arthroplasty, knee arthroplasty, and revision knee arthroplasty. Results: A total of 118 patients with hemophilia and 3,811 controls were identified. Compared with controls, patients with hemophilia had a higher risk of bleeding complications after hip procedures (38.7% versus 16.1%, p = 0.003), a higher risk of surgical site infection after knee procedures (8.1% versus 1.1%, p < 0.001), longer median LOS after hip (6 versus 3 days, p < 0.001) and knee (5 versus 3 days, p < 0.001) procedures, and higher rates of unplanned 30-day readmission after hip (22.6% versus 4.1%, p < 0.001) and knee (10.3% versus 4.5%, p = 0.018) procedures. The most common reason for unplanned 30-day readmission in patients with hemophilia was bleeding or the patient’s underlying coagulopathy (25.1%). Conclusions: Patients with hemophilia undergoing hip or knee arthroplasty had a higher incidence of postoperative bleeding (hip procedures) and surgical site infections (knee procedures), longer LOS, and higher rates of unplanned 30-day readmission compared with nonhemophilic controls. Key limitations of our study include the potential for inaccurate coding, the relatively small number of patients in the hemophilia cohort, and the uneven distribution of procedure type in the hemophilia and control cohorts. Level of Evidence: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Trends of outcomes and healthcare utilization following orthopaedic procedures in adults with haemophilia: A 3‐decade retrospective review

“…15,16 It is also plausible that knee arthroplasties were offered at a later age due to changes in surgical practices, as it has been well documented that PWH had higher rates of bleeding and prosthetic infections compared with the non-haemophilia population. 10,11,16 In contrast to the U.S. UDC study which reports a decline in orthopaedic surgeries across all joint groups (including ankle arthrodesis), we found an increased uptake of ankle arthrodesis over the past decade, performed at a younger age. 8 This is in keeping with previous findings that the ankle joint may still be prone to bleeds or micro-bleeds despite prophylaxis.…”

“…increasing the factor trough levels with the advent of personalized prophylaxis, pharmacological and non‐pharmacological modalities of pain management, accessibility to physiotherapy) 15,16 . It is also plausible that knee arthroplasties were offered at a later age due to changes in surgical practices, as it has been well documented that PWH had higher rates of bleeding and prosthetic infections compared with the non‐haemophilia population 10,11,16 …”

“…Most studies on orthopaedic surgeries in persons with haemophilia (PWH) focused on joint and functional outcomes, with scarce data on healthcare resource utilization such as hospital length of stay (LOS) and coagulation factor utilization. Of the few studies evaluating LOS data, comparisons were typically made between PWH and non‐haemophilia controls 9–11 . However, the temporal trends in the LOS and coagulation factor utilization for orthopaedic procedures are unclear.…”

“…Of the few studies evaluating LOS data, comparisons were typically made between PWH and non-haemophilia controls. [9][10][11] However, the temporal trends in the LOS and coagulation factor utilization for orthopaedic procedures are unclear. In addition, it is unclear whether improved comprehensive haemophilia care together with advanced surgical techniques and shorter LOS have reduced perioperative complications over time.…”

“…A single centre U.K. study examining the 10-year experience (2000-2010) of TKA (n = 13) in 11 individuals with haemophilia B reported a median LOS of 14 days 13. On the other hand, a recent U.S. study of 118 PWH reported a median LOS of 6 days for THA and 5 days for TKA in a more contemporary era(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015) 10. Differences in LOS following major orthopaedic surgeries may be attributed to local surgical practice patterns, the proportion of individuals on routine prophylaxis at the time of surgery, accessibility of outpatient-based rehabilitation programs.…”