How does systemic lupus erythematosus impact the peri-operative complication rates in primary hip arthroplasty? A national inpatient sample-based study.

Abstract

With prolonged life expectancy, the number of patients with systemic lupus erythematosus (SLE) undergoing total hip arthroplasty (THA) has substantially increased over the past years. The post-operative outcome and complications in SLE are less clearly understood than other inflammatory diseases, due to limited availability of evidence within the literature. Using the National Inpatient Sample (NIS) database, patients who underwent THA between 2016 and 2019 were identified (ICD-10 CMP code). Patients were then classified into one of the two groups, namely those with SLE (ICD-10-CM; code710.0) or those without SLE (NSLE). Data regarding demographic details, co-morbidities, details regarding hospital stay, expenditure incurred, and complications encountered were analyzed, and compared between the groups. Overall, among 367,894 patients undergoing THA, 1684 (0.5%) had SLE. Mean age of SLE (57.3 ± 14.5years) patients undergoing THA was significantly lower than NSLE (65.9 ± 11.4years) population (p = 0.001). There was a greater proportion of female patients in SLE group [89.6% (SLE) vs 55.8% (NSLE); p = 0.001]. SLE patients had a greater incidence of emergent hospital admissions (p = 0.04), longer hospital stay (p = 0.001), and higher hospital-related expenditure (p = 0.001). Among the peri-operative complications, SLE patients had significantly greater risk of developing post-operative anemia (p = 0.001), need for blood transfusion (p = 0.001), peri-prosthetic mechanical complications (p = 0.04), and prosthetic dislocations (p = 0.001). There was also a greater incidence of peri-prosthetic infections in the SLE group (p = 0.001). The presence of SLE significantly lengthens hospital stay and augments healthcare-related costs in patients undergoing THA. The three main complications which may significantly affect the post-operative course of these patients include higher rates of post-operative anemia, peri-prosthetic infections, and early prosthetic dislocations.