Impact of Chronic Obstructive Pulmonary Disease on Outcomes After Total Joint Arthroplasty: A Meta-analysis and Systematic Review

Kyun-Ho Shin; Jin-Uk Kim; Il-Tae Jang; Seung-Beom Han; Sang-Bum Kim

doi:10.1007/s43465-022-00794-2

Impact of Chronic Obstructive Pulmonary Disease on Outcomes After Total Joint Arthroplasty: A Meta-analysis and Systematic Review

Indian J Orthop. 2022 Dec 10;57(2):211-226. doi: 10.1007/s43465-022-00794-2. eCollection 2023 Feb.

Authors

Kyun-Ho Shin¹, Jin-Uk Kim¹, Il-Tae Jang², Seung-Beom Han³, Sang-Bum Kim⁴

Affiliations

¹ Department of Orthopedic Surgery, Incheon Nanoori Hospital, 156 Janje-ro, Bupyeong-gu, 21353 Incheon, South Korea.
² Department of Neurosurgery, Gangnam Nanoori Hospital, Seoul, South Korea.
³ Department of Orthopedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
⁴ Joint Center, Inbone Hospital, Paju-si, Gyeonggi-do South Korea.

Abstract

Background: Comorbid chronic obstructive pulmonary disease (COPD) is increasingly common and may have an adverse impact on outcomes in patients undergoing total joint arthroplasty (TJA) of lower extremity. The purpose of this meta-analysis is to compare the postoperative complications between COPD and non-COPD patients undergoing primary TJA including total hip and knee arthroplasty.

Methods: PubMed, EMBASE, and Cochrane Library were systematically searched for relevant studies published before December 2021. Postoperative outcomes were compared between patients with COPD versus those without COPD as controls. The outcomes were mortality, re-admission, pulmonary, cardiac, renal, thromboembolic complications, surgical site infection (SSI), periprosthetic joint infection (PJI), and sepsis.

Results: A total of 1,002,779 patients from nine studies were finally included in this meta-analysis. Patients with COPD had an increased risk of mortality (OR [odds ratio] = 1.69, 95% confidence interval [CI] 1.42-2.02), re-admission (OR = 1.54, 95% CI 1.38-1.71), pulmonary complications (OR = 2.73, 95% CI 2.26-3.30), cardiac complications (OR = 1.40, 95% CI 1.15-1.69), thromboembolic complications (OR = 1.21, 95% CI 1.15-1.28), renal complications (OR = 1.50, 95% CI 1.14-1.26), SSI (OR = 1.23, 95% CI 1.18-1.30), PJI (OR = 1.26, 95% CI 1.15-1.38), and sepsis (OR = 1.36, 95% CI 1.22-1.52).

Conclusion: Patients with comorbid COPD showed an increased risk of mortality and postoperative complications following TJA compared with patients without COPD. Therefore, orthopedic surgeons can use the study to adequately educate these potential complications when obtaining informed consent. Furthermore, preoperative evaluation and medical optimization are crucial to minimizing postoperative complications from arising in this difficult-to-treat population.

Level of evidence: Level III.

Registration: None.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-022-00794-2.

Keywords: Chronic obstructive pulmonary disease; Meta-analysis; Postoperative complications; Systematic reviews; Total hip arthroplasty; Total joint arthroplasty; Total knee arthroplasty.

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