Pre-hospital medications in total hip arthroplasty: risk factors for poor outcomes.

INTRODUCTION

The influence of co-morbidities on complication rates and length of hospitalisation after surgery is well recognised. Clinical instruments predicting this influence, are of increasing interest. We sought to determine whether a count of a patient's preoperative pharmaceuticals would be associated to postoperative outcomes.

MATERIAL AND METHODS

In this retrospective, consecutive case series, 668 patients undergoing elective primary total hip arthroplasty (THA) were analysed. Age, gender, BMI, ASA-classification, nicotine or alcohol abuse, and the number and type of medications were documented.

RESULTS

Mean age was 63 years (18-94), 53% were females. A total of 60 (8.9%) local and 19 (2.8%) systemic complications occurred during hospital stay. A total of 11 (1.6%) patients died, while 49 (7.3%) local complications occurred during the first postoperative year. Length of hospital stay, blood transfusions, and morbidity were found to be significantly related to the quantity of medications (p<0.001). While the risk of an extended hospital stay (>7 days) increased by a factor of 1.15 (CI: 1.08-1.22) with each medication, the risk of experiencing a complication within the first postoperative year was 1.19 times (CI: 1.07-1.29) for each additional medication. Type of medication also influenced morbidity: the odds ratio was 1.89 (CI: 1.05-3.41) for platelet inhibiting agents and 4.07 (CI: 1.96-8.42) for oral anticoagulants in early morbidity, which increased to 6.05 (CI:2.92-12.53) in 1-year follow-up.

CONCLUSIONS

The investigation illustrated the significant influence of the number and/or type of medication on complications, morbidity and prolonged hospital stay. This predictive tool may be useful, for physicians and non-health professionals, in estimating particular outcomes after elective THA.