Metabolic syndrome increases the length of stay and medical complications after hip and knee arthroplasty: results from a prospective cohort study of 2,901 patients
DOI:
https://doi.org/10.2340/17453674.2024.42112Keywords:
Arthroplasty, Hip, Knee, Metabolic syndromeAbstract
Background and purpose: Metabolic syndrome (MetS) affects more than 60% of the patients having a hip or knee arthroplasty due to osteoarthritis. As it is debated whether metabolic syndrome increases the risk of complications, we aimed to investigate the length of stay (LOS) and risk of readmission at 30 and 90 days after surgery, including causes of readmission.
Methods: We conducted a prospective cohort study of 2,901 patients undergoing hip and knee arthroplasty from May 2017 to November 2019. Physical examination, blood samples, and medical history from national registries determined the diagnosis of metabolic syndrome from the International Diabetes Federation definition. We used multivariate linear regression to investigate differences in LOS according to MetS, and binary regression to investigate the risk and causes of readmission within 30 and 90 days, including 95% confidence intervals (CI) and P values.
Results: Patients with MetS showed a slightly longer LOS (0.20 days, CI 0.10–0.29) and had an increased risk of readmission within 90 days (adjusted relative risk [RR] 1.2, CI 1.0–1.4; P = 0.02), but not within 30 days (adjusted RR 1.1, CI 0.9–1.4; P = 0.3) after surgery. Cardiovascular disease was the dominant cause of readmission.
Conclusion: Although patients with MetS do not experience a clinically relevant longer LOS after hip and knee arthroplasty, they have an increased risk of 90-day readmission mainly due to cardiovascular complications, which should be considered when planning surgical care in this group of patients.
Downloads
References
Husted H, Jensen C M, Solgaard S, Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Trauma Surg 2012; 132: 101-4. doi: 10.1007/s00402-011-1396-0.
Khan S K, Malviya A, Muller S D, Carluke I, Partington P F, Emmerson K P, et al. Reduced short-term complications and mortality following Enhanced Recovery primary hip and knee arthroplasty: results from 6,000 consecutive procedures. Acta Orthop 2014; 85: 26-31. doi: 10.3109/17453674.2013.874925.
Saucedo J M, Marecek G S, Wanke T R, Lee J, Stulberg S D, Puri L. Understanding readmission after primary total hip and knee arthroplasty: who’s at risk? J Arthroplasty 2014; 29: 256-60. doi: 10.1016/j.arth.2013.06.003.
Wallace G, Judge A, Prieto-Alhambra D, de Vries F, Arden N K, Cooper C. The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery. Osteoarthritis Cartilage 2014; 22: 918-927. doi: 10.1016/j.joca.2014.04.013.
Kassi E, Pervanidou P, Kaltsas G, Chrousos G. Metabolic syndrome: definitions and controversies. BMC Med 2011; 9: 48. doi: 10.1186/1741-7015-9-48.
Puenpatom RA, Victor T W. Increased prevalence of metabolic syndrome in individuals with osteoarthritis: an analysis of NHANES III data. Postgrad Med 2009; 121: 9-20. doi: 10.3810/pgm.2009.11.2073.
Sherling D H, Perumareddi P, Hennekens C H. Metabolic syndrome. J Cardiovasc Pharmacol Ther 2017; 22: 365-7. doi: 10.1177/1074248416686187.
Guofeng C, Chen Y, Rong W, Ruiyu L, Kunzheng W. Patients with metabolic syndrome have a greater rate of complications after arthroplasty: a systematic review and meta-analysis. Bone Joint Res 2020; 9: 120-9. doi: 10.1302/2046-3758.93.BJR-2019-0138.R1.
Gomes M, Gutacker N, Bojke C, Street A. Addressing Missing Data in Patient-Reported Outcome Measures (PROMS): implications for the use of PROMS for comparing provider performance. Health Econ 2016; 25: 515-28. doi: 10.1002/hec.3173.
Gutacker N, Street A, Gomes M, Bojke C. Should English healthcare providers be penalised for failing to collect patient-reported outcome measures? A retrospective analysis. J R Soc Med 2015; 108: 304-16. doi: 10.1177/0141076815576700.
Sørensen R R, Timm S, Rasmussen L E, Brasen C L, Varnum C. Metabolic syndrome and morbid obesity are not risk factors for revision surgery in patients undergoing hip and knee arthroplasty. J Arthroplasty 2024; doi: 10.1016/j.arth.2024.07.013.
Husted H. Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl 2012; 83: 1-39. doi: 10.3109/17453674.2012.700593.
Andersen T F, Madsen M, Jorgensen J, Mellemkjoer L, Olsen J H. The Danish National Hospital Register: a valuable source of data for modern health sciences. Dan Med Bull 1999; 46: 263-8.
Charlson M E, Pompei P, Ales K L, MacKenzie C R. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83. doi: 10.1016/0021-9681(87)90171-8
Pottegard A, Schmidt SA J, Wallach-Kildemoes H, Sorensen H T, Hallas J, Schmidt M. Data resource profile: the Danish National Prescription Registry. Int J Epidemiol 2017; 46: 798-798f. doi: 10.1093/ije/dyw213.
Pedersen A, Johnsen S, Overgaard S, Soballe K, Sorensen H T, Lucht U. Registration in the Danish Hip Arthroplasty Registry: completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications. Acta Orthop Scand 2004; 75: 434-41. doi: 10.1080/00016470410001213-1.
Pedersen A B, Mehnert F, Odgaard A, Schroder H M. Existing data sources for clinical epidemiology: the Danish Knee Arthroplasty Register. Clin Epidemiol 2012; 4: 125-35. doi: 10.2147/CLEP.S30050.
Gundtoft P H, Varnum C, Pedersen A B, Overgaard S. The Danish Hip Arthroplasty Register. Clin Epidemiol 2016; 8: 509-14. doi: 10.2147/CLEP.S99498.
Zimmet P, Magliano D, Matsuzawa Y, Alberti G, Shaw J. The metabolic syndrome: a global public health problem and a new definition. J Atheroscler Thromb 2005; 12: 295-300. doi: 10.5551/jat.12.295.
Austin P C. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009; 28: 3083-107. doi: 10.1002/sim.3697
Christensen R, Ranstam J, Overgaard S, Wagner P. Guidelines for a structured manuscript: statistical methods and reporting in biomedical research journals. Acta Orthop 2023; 94: 243-9. doi: 10.2340/17453674.2023.11656.
Husted H, Jorgensen C C, Gromov K, Kehlet H, Lundbeck Foundation Center for Fast-track H, Knee Replacement Collaborative G. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty? Acta Orthop 2016; 87: 466-72. doi: 10.1080/17453674.2016.1203477.
Roger C, Debuyzer E, Dehl M, Bulaid Y, Lamrani A, Havet E, et al. Factors associated with hospital stay length, discharge destination, and 30-day readmission rate after primary hip or knee arthroplasty: Retrospective Cohort Study. Orthop Traumatol Surg Res 2019; 105: 949-55. doi: 10.1016/j.otsr.2019.04.012.
Inneh I A, Iorio R, Slover J D, Bosco J A, 3rd. Role of sociodemographic, co-morbid and intraoperative factors in length of stay following primary total hip arthroplasty. J Arthroplasty 2015; 30: 2092-7. doi: 10.1016/j.arth.2015.06.054.
Dey S, Gadde R, Sobti A, Macdonald N, Jacob J, Unnithan A. The safety and efficacy of day-case total joint arthroplasty. Ann R Coll Surg Engl 2021; 103: 638-44. doi: 10.1308/rcsann.2021.0066.
Picart B, Lecoeur B, Rochcongar G, Dunet J, Pegoix M, Hulet C. Implementation and results of an enhanced recovery (fast-track) program in total knee replacement patients at a French university hospital. Orthop Traumatol Surg Res 2021; 107: 102851. doi: 10.1016/j.otsr.2021.102851.
Podmore B, Hutchings A, Skinner J A, MacGregor A J, van der Meulen J. Impact of comorbidities on the safety and effectiveness of hip and knee arthroplasty surgery. Bone Joint J 2021; 103-B: 56-64. doi: 10.1302/0301-620X.103B1.BJJ-2020-0859.R1.
Gandhi R, Razak F, Tso P, Davey J R, Mahomed N N. Metabolic syndrome and the incidence of symptomatic deep vein thrombosis following total knee arthroplasty. J Rheumatol 2009; 36: 2298-301. doi: 10.3899/jrheum.090282.
Gandhi K, Viscusi E R, Schwenk E S, Pulido L, Parvizi J. Quantifying cardiovascular risks in patients with metabolic syndrome undergoing total joint arthroplasty. J Arthroplasty 2012; 27: 514-19. doi: 10.1016/j.arth.2011.06.027.
Edelstein A I, Lovecchio F, Delagrammaticas D E, Fitz D W, Hardt K D, Manning D W. The impact of metabolic syndrome on 30-day complications following total joint arthroplasty. J Arthroplasty 2017; 32: 362-6. doi: 10.1016/j.arth.2016.08.007.
Song K, Rong Z, Yao Y, Shen Y, Zheng M, Jiang Q. Metabolic syndrome and deep vein thrombosis after total knee and hip arthroplasty. J Arthroplasty 2016; 31: 1322-5. doi: 10.1016/j.arth.2015.12.021.
Berg U, BuLow E, Sundberg M, Rolfson O. No increase in readmissions or adverse events after implementation of fast-track program in total hip and knee replacement at 8 Swedish hospitals: an observational before-and-after study of 14,148 total joint replacements 2011–2015. Acta Orthop 2018; 89: 522-7. doi: 10.1080/17453674.2018.1492507.
Malahias M A, Gu A, Adriani M, Addona J L, Alexiades M M, Sculco P K. Comparing the safety and outcome of simultaneous and staged bilateral total knee arthroplasty in contemporary practice: a systematic review of the literature. J Arthroplasty 2019; 34: 1531-7. doi: 10.1016/j.arth.2019.03.046.
George J, Chughtai M, Khlopas A, Klika A K, Barsoum W K, Higuera CA, et al. Readmission, reoperation, and complications: total hip vs total knee arthroplasty. J Arthroplasty 2018; 33: 655-60. doi: 10.1016/j.arth.2017.09.048.
Additional Files
Published
How to Cite
License
Copyright (c) 2024 Rasmus Reinholdt Sørensen , Signe Timm, Lasse Enkebølle Rasmussen, Claus Lohman Brasen, Claus Varnum
This work is licensed under a Creative Commons Attribution 4.0 International License.
