Does well-controlled overt hypothyroidism increase the risk of total knee arthroplasty?

Elevated risk of medical and implant-related complications in patients with hypothyroidism after total shoulder arthroplasty: a 1:1 propensity matched cohort analysis

BACKGROUND

There is currently limited work that evaluates the effect of comorbid hypothyroidism on complications and outcomes following total shoulder arthroplasty (TSA). This study aims to evaluate the impact of hypothyroidism on 90-day medical complications as well as 2-year implant related complications and revision rates following TSA.

METHODS

This retrospective database analysis evaluated patients who underwent TSA between October 1, 2015, and March 9, 2022. Patients with 2-year follow-up were categorized based on the presence of preoperative hypothyroidism within three months before TSA versus euthyroid status, resulting in 7716 hypothyroid and 46,568 euthyroid patients. A 1:1 propensity score matching was performed, adjusting for age, gender, race, ethnicity, and comorbid conditions (diabetes, hypertension, chronic kidney disease, tobacco use, obesity, heart failure, and liver diseases). Postoperative complications were assessed at 90 days, and implant-related complications were evaluated at two years. A Bonferroni correction was applied to account for multiple comparisons.

RESULTS

After matching, 7716 matched patients were included in each cohort. Hypothyroid patients had significantly higher risks of sepsis, infection, pulmonary embolism, stroke, and hospital readmission (all P < .0001), as well as higher rates of anemia, pneumonia, renal failure, and blood transfusion requirements (all P < .0001) within 90 days postoperatively. Myocardial infarction did not meet the significance threshold (P = .005). At 2 years, these patients had elevated rates of periprosthetic fractures, prosthetic joint infection, dislocation, revision surgeries, and mechanical loosening (all P < .0001).

CONCLUSION

Hypothyroidism is associated with an increased risk of 90-day medical complications and 2-year implant-related complications following shoulder arthroplasty. Further investigation into these findings and potential for perioperative medical optimization is indicated.

Incidence and risk factors of blood transfusion after total knee arthroplasty: A retrospective nationwide inpatient sample database study

Introduction

Common postoperative complications of total knee arthroplasty (TKA) include blood transfusion. Although risk factors and incidence of blood transfusion have been studied through national databases, the relative impact of each risk factor needs to be synthesized over a longer time period into a new model need to be revised.

Material and methods

Patient data were extracted from the National Inpatient Sample (NIS), which is the largest hospital care database in the US, and analyse patient data retrospectively from 2010 through 2019. The final data included the patients undergoing TKA. The final analysis assessed the demographics of patients, type of insurance, type of hospital, length of stay (LOS), preoperative comorbidities, total charge, inpatient mortality, medical-surgical postoperative complications.

Results

After extracting data from the NIS database, a total of 1,250,533 patients with TKA were included in the analysis, and the rate of transfusion was 6.60 %. TKA patients who receive blood transfusion had longer LOS (from 2-3 days to 3-4 days), more preoperative comorbidities, higher inpatient mortality rate, and increased total charge (P < 0.001). Moreover, postoperative complications associated with inpatients included sepsis, acute myocardial infarction and shock. Elective admission and private insurance were also regarded as protective factors.

Conclusion

Blood transfusion could bring postoperative complications to patients, which were also linked to health costs and risks. It was also a common preoperative comorbidities for older patients who underwent TKA. Through better blood management strategies, we could reduce patient transfusion rates and improve clinical outcomes.Level of Evidence: Diagnostic Level Ⅲ.

Suboptimal Thyroid Hormone Replacement Is Associated With Worse Hospital Outcomes

CONTEXT

Many patients with hypothyroidism receive suboptimal treatment that may affect hospital outcomes.

OBJECTIVE

This work aimed to identify differences in hospital outcomes between patients with and without hypothyroidism.

METHODS

A retrospective cohort study, using the propensity score-based fine stratification method to balance covariates, was conducted using a large, US-based, commercial claims database from January 1, 2008 to December 31, 2015. Participants included patients aged 64 years and younger who had a thyrotropin (TSH) level collected before a hospital admission. Covariates included age, sex, US region, type of admission, year of admission, and comorbidities. Exposure included clinical hypothyroidism, which was divided into 4 subgroups based on prehospitalization TSH level: low (TSH < 0.40 mIU/L), normal (TSH 0.40-4.50 mIU/L), intermediate (TSH 4.51-10.00 mIU/L), and high (TSH > 10.00 mIU/L).

MAIN OUTCOME MEASURES INCLUDED

length of stay (LOS), in-hospital mortality, and readmission outcomes.

RESULTS

A total of 43 478 patients were included in the final study population, of whom 8873 had a diagnosis of hypothyroidism. Those with a high prehospitalization TSH level had an LOS that was 1.2 days longer (95% CI, 1.1-1.3; P = .003), a 49% higher risk of 30-day readmission (relative risk [RR] 1.49; 95% CI, 1.20-1.85; P < .001), and a 43% higher rate of 90-day readmission (RR 1.43; 95% CI, 1.21-1.67; P < .001) compared to balanced controls. Patients with normal TSH levels exhibited decreased risk of in-hospital mortality (RR 0.46; 95% CI, 0.27-0.79; P = .004) and 90-day readmission (RR 0.92; 95% CI, 0.85-0.99; P = .02).

CONCLUSION

The results suggest suboptimal treatment of hypothyroidism is associated with worse hospital outcomes, including longer LOS and higher rate of readmission.