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

Thita Chiasakul; Tyler W Buckner; Mingyang Li; Rolando Vega; Phyllis A Gimotty; Adam Cuker

doi:10.2106/JBJS.OA.19.00085

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

JB JS Open Access. 2020 Jun 5;5(2):e0085. doi: 10.2106/JBJS.OA.19.00085. eCollection 2020 Apr-Jun.

Authors

Thita Chiasakul¹, Tyler W Buckner², Mingyang Li³, Rolando Vega³, Phyllis A Gimotty³, Adam Cuker³

Affiliations

¹ Division of Hematology, Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.
² Hemophilia and Thrombosis Center, University of Colorado School of Medicine, Aurora, Colorado.
³ Departments of Biostatistics, Epidemiology and Informatics (M.L. and P.A.G.), Medicine (R.V. and A.C.), and Pathology and Laboratory Medicine (A.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

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.