Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates
This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19. A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee ar...
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| Veröffentlicht in: | The Journal of arthroplasty 2023-09, Vol.38 (9), p.1682-1692.e2 |
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| container_title | The Journal of arthroplasty |
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| creator | Heckmann, Nathanael D. Wang, Jennifer C. Piple, Amit S. Bouz, Gabriel J. Chung, Brian C. Oakes, Daniel A. Christ, Alexander B. Lieberman, Jay R. |
| description | This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19.
A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not. Differences between groups were assessed using univariate and multivariate analyses. Overall, 712 COVID-19 patients were matched to 4,272 controls (average time to diagnosis: 128-117 days [range, 0-351]).
Of patients diagnosed |
| doi_str_mv | 10.1016/j.arth.2023.04.052 |
| format | Article |
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A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not. Differences between groups were assessed using univariate and multivariate analyses. Overall, 712 COVID-19 patients were matched to 4,272 controls (average time to diagnosis: 128-117 days [range, 0-351]).
Of patients diagnosed <90 days postoperatively, 32.5%-33.6% required COVID-19-driven readmission. Discharge to a skilled nursing facility (adjusted odds ratio [aOR] 1.72, P = .003) or acute rehabilitation unit (aOR 4.93, P < .001) and Black race (aOR 2.28, P < .001) were associated with readmission after TKA. Similar results were associated with THA. COVID-19 patients were at increased risk of pulmonary embolism (aOR 4.09, P = .001) after TKA and also periprosthetic joint infection (aOR 4.65, P < .001) and sepsis (aOR 11.11, P < .001) after THA. The mortality rate was 3.51% in COVID-19 patients and 7.94% in readmitted COVID-19 patients compared to 0.09% in controls, representing a 38.7 OR and 91.8 OR of death, respectively. Similar results were observed for TKA and THA separately.
Patients who contracted COVID-19 following TJA were at greater risk of numerous complications, including death. These patients represent a high-risk cohort who may require more aggressive medical interventions. Given the potential limitations presently, prospectively collected data may be warranted to validate these findings.</description><identifier>ISSN: 0883-5403</identifier><identifier>EISSN: 1532-8406</identifier><identifier>DOI: 10.1016/j.arth.2023.04.052</identifier><identifier>PMID: 37142066</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>complications ; COVID-19 ; mortality ; total hip arthroplasty ; total knee arthroplasty</subject><ispartof>The Journal of arthroplasty, 2023-09, Vol.38 (9), p.1682-1692.e2</ispartof><rights>2023 Elsevier Inc.</rights><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023 Elsevier Inc. All rights reserved. 2023 Elsevier Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-f3fc1f8cd9092beb33fc603bf1b425772e2e40b33a36fd72e167eaa2c519511a3</citedby><cites>FETCH-LOGICAL-c456t-f3fc1f8cd9092beb33fc603bf1b425772e2e40b33a36fd72e167eaa2c519511a3</cites><orcidid>0000-0003-1293-1702</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.arth.2023.04.052$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37142066$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Heckmann, Nathanael D.</creatorcontrib><creatorcontrib>Wang, Jennifer C.</creatorcontrib><creatorcontrib>Piple, Amit S.</creatorcontrib><creatorcontrib>Bouz, Gabriel J.</creatorcontrib><creatorcontrib>Chung, Brian C.</creatorcontrib><creatorcontrib>Oakes, Daniel A.</creatorcontrib><creatorcontrib>Christ, Alexander B.</creatorcontrib><creatorcontrib>Lieberman, Jay R.</creatorcontrib><title>Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates</title><title>The Journal of arthroplasty</title><addtitle>J Arthroplasty</addtitle><description>This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19.
A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not. Differences between groups were assessed using univariate and multivariate analyses. Overall, 712 COVID-19 patients were matched to 4,272 controls (average time to diagnosis: 128-117 days [range, 0-351]).
Of patients diagnosed <90 days postoperatively, 32.5%-33.6% required COVID-19-driven readmission. Discharge to a skilled nursing facility (adjusted odds ratio [aOR] 1.72, P = .003) or acute rehabilitation unit (aOR 4.93, P < .001) and Black race (aOR 2.28, P < .001) were associated with readmission after TKA. Similar results were associated with THA. COVID-19 patients were at increased risk of pulmonary embolism (aOR 4.09, P = .001) after TKA and also periprosthetic joint infection (aOR 4.65, P < .001) and sepsis (aOR 11.11, P < .001) after THA. The mortality rate was 3.51% in COVID-19 patients and 7.94% in readmitted COVID-19 patients compared to 0.09% in controls, representing a 38.7 OR and 91.8 OR of death, respectively. Similar results were observed for TKA and THA separately.
Patients who contracted COVID-19 following TJA were at greater risk of numerous complications, including death. These patients represent a high-risk cohort who may require more aggressive medical interventions. Given the potential limitations presently, prospectively collected data may be warranted to validate these findings.</description><subject>complications</subject><subject>COVID-19</subject><subject>mortality</subject><subject>total hip arthroplasty</subject><subject>total knee arthroplasty</subject><issn>0883-5403</issn><issn>1532-8406</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9UU1vEzEQtRCIhsIf4IB85LJbf252ERKq0hZSFbVChavl9c6mjhw72E5QxJ_HaUpVLpxGM37v-c08hN5SUlNCm5NlrWO-qxlhvCaiJpI9QxMqOataQZrnaELalldSEH6EXqW0JIRSKcVLdMSnVDDSNBP0-yYkm-0W8Oz6x_ysoh0-s3rhyzThi-Bc-GX9At9Eu9Jxh88dmHv0bcja4ctgfcanxUUMa6dT3n3Ac28i6AQDnoXV2lmjsw0eaz_gryEWls07_E1nSK_Ri1G7BG8e6jH6fnF-O_tSXV1_ns9OryojZJOrkY-Gjq0ZOtKxHnpe-obwfqS9YHI6ZcBAkDLWvBmH0tJmClozI2knKdX8GH066K43_QoGAz5H7dT6sJMK2qp_X7y9U4uwVeXKkjJJisL7B4UYfm4gZbWyyYBz2kPYJMVaSjraFbsFyg5QE0NKEcbHfyjZCzZqqfaxqX1sighVYiukd08dPlL-5lQAHw8AKHfaWogqGQvewGBjSUQNwf5P_w9hA6u1</recordid><startdate>20230901</startdate><enddate>20230901</enddate><creator>Heckmann, Nathanael D.</creator><creator>Wang, Jennifer C.</creator><creator>Piple, Amit S.</creator><creator>Bouz, Gabriel J.</creator><creator>Chung, Brian C.</creator><creator>Oakes, Daniel A.</creator><creator>Christ, Alexander B.</creator><creator>Lieberman, Jay R.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-1293-1702</orcidid></search><sort><creationdate>20230901</creationdate><title>Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates</title><author>Heckmann, Nathanael D. ; Wang, Jennifer C. ; Piple, Amit S. ; Bouz, Gabriel J. ; Chung, Brian C. ; Oakes, Daniel A. ; Christ, Alexander B. ; Lieberman, Jay R.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c456t-f3fc1f8cd9092beb33fc603bf1b425772e2e40b33a36fd72e167eaa2c519511a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>complications</topic><topic>COVID-19</topic><topic>mortality</topic><topic>total hip arthroplasty</topic><topic>total knee arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Heckmann, Nathanael D.</creatorcontrib><creatorcontrib>Wang, Jennifer C.</creatorcontrib><creatorcontrib>Piple, Amit S.</creatorcontrib><creatorcontrib>Bouz, Gabriel J.</creatorcontrib><creatorcontrib>Chung, Brian C.</creatorcontrib><creatorcontrib>Oakes, Daniel A.</creatorcontrib><creatorcontrib>Christ, Alexander B.</creatorcontrib><creatorcontrib>Lieberman, Jay R.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of arthroplasty</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Heckmann, Nathanael D.</au><au>Wang, Jennifer C.</au><au>Piple, Amit S.</au><au>Bouz, Gabriel J.</au><au>Chung, Brian C.</au><au>Oakes, Daniel A.</au><au>Christ, Alexander B.</au><au>Lieberman, Jay R.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates</atitle><jtitle>The Journal of arthroplasty</jtitle><addtitle>J Arthroplasty</addtitle><date>2023-09-01</date><risdate>2023</risdate><volume>38</volume><issue>9</issue><spage>1682</spage><epage>1692.e2</epage><pages>1682-1692.e2</pages><issn>0883-5403</issn><eissn>1532-8406</eissn><abstract>This study analyzed complication rates following primary elective total joint arthroplasty (TJA) in patients who subsequently contracted COVID-19.
A large national database was queried for adult patients who underwent primary elective TJA in 2020. Patients who contracted COVID-19 after total knee arthroplasty (TKA) or total hip arthroplasty (THA) underwent 1:6 matching (age [±6 years], sex, month of surgery, COVID-19-related comorbidities) to patients who did not. Differences between groups were assessed using univariate and multivariate analyses. Overall, 712 COVID-19 patients were matched to 4,272 controls (average time to diagnosis: 128-117 days [range, 0-351]).
Of patients diagnosed <90 days postoperatively, 32.5%-33.6% required COVID-19-driven readmission. Discharge to a skilled nursing facility (adjusted odds ratio [aOR] 1.72, P = .003) or acute rehabilitation unit (aOR 4.93, P < .001) and Black race (aOR 2.28, P < .001) were associated with readmission after TKA. Similar results were associated with THA. COVID-19 patients were at increased risk of pulmonary embolism (aOR 4.09, P = .001) after TKA and also periprosthetic joint infection (aOR 4.65, P < .001) and sepsis (aOR 11.11, P < .001) after THA. The mortality rate was 3.51% in COVID-19 patients and 7.94% in readmitted COVID-19 patients compared to 0.09% in controls, representing a 38.7 OR and 91.8 OR of death, respectively. Similar results were observed for TKA and THA separately.
Patients who contracted COVID-19 following TJA were at greater risk of numerous complications, including death. These patients represent a high-risk cohort who may require more aggressive medical interventions. Given the potential limitations presently, prospectively collected data may be warranted to validate these findings.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>37142066</pmid><doi>10.1016/j.arth.2023.04.052</doi><orcidid>https://orcid.org/0000-0003-1293-1702</orcidid><oa>free_for_read</oa></addata></record> |
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| source | ScienceDirect Journals (5 years ago - present) |
| subjects | complications COVID-19 mortality total hip arthroplasty total knee arthroplasty |
| title | Positive COVID-19 Diagnosis Following Primary Elective Total Joint Arthroplasty: Increased Complication and Mortality Rates |
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