Hypothyroidism Impacts Clinical and Healthcare Utilization Outcomes After Primary Total Hip Arthroplasty

Sumanth R Chandrupatla; Kranti C Rumalla; Jasvinder A Singh

doi:10.1016/j.arth.2023.11.005

Hypothyroidism Impacts Clinical and Healthcare Utilization Outcomes After Primary Total Hip Arthroplasty

J Arthroplasty. 2023 Nov 14:S0883-5403(23)01127-0. doi: 10.1016/j.arth.2023.11.005. Online ahead of print.

Authors

Sumanth R Chandrupatla¹, Kranti C Rumalla², Jasvinder A Singh³

Affiliations

¹ Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama.
² Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
³ Department of Medicine at the School of Medicine, University of Alabama at Birmingham (UAB), Birmingham, Alabama; Medicine Service, VA Medical Center, Birmingham, Alabama; Department of Epidemiology at the UAB School of Public Health, Birmingham, Alabama; Division of Clinical Immunology and Rheumatology, Musculoskeletal Outcomes Research, Birmingham, Alabama; Gout Clinic, University of Alabama Health Sciences Foundation, Birmingham, Alabama; Birmingham Veterans Affairs Medical Center, Birmingham, Alabama.

PMID: 37972668
DOI: 10.1016/j.arth.2023.11.005

Abstract

Background: Our objective was to assess the association of hypothyroidism with outcomes of primary total hip arthroplasty (THA) overall and stratified by underlying diagnosis.

Methods: We identified patients undergoing primary THA in a national database from 2016 to 2020. We stratified them based on primary diagnoses into hip osteoarthritis (OA; N = 1,761,960), osteonecrosis (ON; N = 78,275), traumatic fracture (N = 532,910), inflammatory arthritis (IA; N = 3,520), and "other" (N = 90,550). We identified hypothyroidism and complications using secondary diagnoses. Among 2,467,215 patients undergoing primary THA, mean age was 68 years (range, 18 to 90), and 58.3% were women. Complications codes only included initial encounters. We performed time-trends analyses and multivariable-adjusted regression analyses adjusted for demographics, expected primary payer, a comorbidity score, elective versus non-elective admission, and hospital characteristic information, with clinical and healthcare utilization outcome as endpoints.

Results: Overall, hypothyroidism was significantly associated with increased LOS, total charges, non-routine discharges, blood transfusions, and prosthetic fractures. In the OA cohort, hypothyroidism was associated with increased LOS, total charges, and non-routine discharges (P < .001 for each), and blood transfusions (P = .02). Hypothyroidism was associated with increased total charges (P = .001) in the ON cohort and with increased LOS, non-routine discharge, and blood transfusion (P < .05 each) in the traumatic fracture cohort.

Conclusions: Hypothyroidism was associated with blood transfusions, prosthetic fractures, and utilization outcomes in THA patients. Tailored intervention strategies for hypothyroidism should be tested for their efficacy to improve THA peri-operative outcomes.

Keywords: arthritis; hypothyroidism; national inpatient sample; outcomes; total hip arthroplasty.