Abstract
BackgroundTo analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain.MethodsWe selected all surgical admissions in individuals aged ≥ 40 years who underwent RTHA (ICD-9-CM procedure code 81.53) between 2001 and 2008 from the Spanish National Hospital Discharge Database. Age- and sex-specific incidence rates, Charlson co-morbidity index, length of stay (LOS), costs and in-hospital mortality (IHM) were estimated for each year. Multivariate analyses were conducted to asses time trends.Results32, 280 discharges of patients (13, 391 men/18, 889 women) having undergone RTHA were identified. Overall crude incidence showed a small but significant increase from 20.2 to 21.8 RTHA per 100, 000 inhabitants from 2001 to 2008 (p < 0.01).The incidence increased for men (17.7 to 19.8 in 2008) but did not vary for women (22.3 in 2001 and 22.2 in 2008). Greater increments were observed in patients older than 84 years and in the age group 75-84. In 2001, 19% of RTHA patients had a Charlson Index ≥ 1 and this proportion rose to 24.6% in 2008 (p < 0.001). The ratio RTHA/THA remained stable and around 20% in Spain along the entire periodThe crude overall in-hospital mortality (IHM) increased from 1.16% in 2001 to 1.77% (p = 0.025) in 2008. For both sexes the risk of death was higher with age, with the highest mortality rates found among those aged 85 or over. After multivariate analysis no change was observed in IHM over time. The mean inflation adjusted cost per patient increased by 78.3%, from 9, 375 to 16, 715 Euros from 2001 to 2008.After controlling for possible confounders using Poisson regression models, we observed that the incidence of RTHA hospitalizations significantly increased for men and women over the period 2001 to 2008 (IRR 1.10, 95% CI 1.03-1.18 and 1.08, 95% CI 1.02-1.14 respectively).ConclusionsThe crude incidence of RTHA in Spain showed a small but significant increase from 2001 to 2008 with concomitant reductions in LOS, significant increase in co-morbidities and cost per patient.
Highlights
To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain
Background recent reports based on National Arthroplasty Registries show that the overall 10-year survival of total hip arthroplasty (THA) is over 90%, the burden of Revision Total Hip Arthroplasty (RTHA) is growing in developed countries [1,2]
The total costs of RTHA in Spain during our study period increased by 114.4%, from 34.8 million Euros to 74.6 million Euros
Summary
To analyze changes in incidence and outcomes of patients undergoing revision total hip arthroplasty (RTHA) over an 8-year study period in Spain. Recent reports based on National Arthroplasty Registries show that the overall 10-year survival of total hip arthroplasty (THA) is over 90%, the burden of Revision Total Hip Arthroplasty (RTHA) is growing in developed countries [1,2]. Surveys from several countries have reported a continued growth in the use of THA and RTHA over the last decades as a result of ageing populations, the extension of indications and of the age range for this treatment [3,4,5]. In the absence of such a registry, the discharge databases can provide a large alternative information source to describe and analyze the trends and characteristics of THA and RTHA at a national level [11,12]
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