Incidence, Risk Factors, and Subsequent Complications of Postoperative Hematomas Requiring Reoperation After Primary Total Hip Arthroplasty

Neil Pathak, MD; Pat Bovonratwet, MD; James J. Purtill, MD; Jenna A. Bernstein, MD; Marjorie Golden, MD; Jonathan N. Grauer, MD; Lee E. Rubin, MD

Arthroplasty Today (Feb 2023)

Incidence, Risk Factors, and Subsequent Complications of Postoperative Hematomas Requiring Reoperation After Primary Total Hip Arthroplasty

Neil Pathak, MD,
Pat Bovonratwet, MD,
James J. Purtill, MD,
Jenna A. Bernstein, MD,
Marjorie Golden, MD,
Jonathan N. Grauer, MD,
Lee E. Rubin, MD

Affiliations

Neil Pathak, MD: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
Pat Bovonratwet, MD: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
James J. Purtill, MD: Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
Jenna A. Bernstein, MD: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
Marjorie Golden, MD: Department of Infectious Disease, Yale School of Medicine, New Haven, CT, USA
Jonathan N. Grauer, MD: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
Lee E. Rubin, MD: Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA; Corresponding author. Yale School of Medicine, Department of Orthopaedics and Rehabilitation, PO Box 208071, New Haven, CT 06520-8071, USA. Tel.: +1 203 737 4477.

Journal volume & issue: Vol. 19
p. 101015

Abstract

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Background: Studies analyzing the incidence and clinical implications of postoperative hematomas after total hip arthroplasty (THA) remain limited. The purpose of the present study was to use the National Surgical Quality Improvement Program (NSQIP) dataset to determine rates, risk factors, and subsequent complications of postoperative hematomas requiring reoperation after primary THA. Methods: Study population included patients who underwent primary THA (CPT code: 27130) from 2012-2016 recorded in NSQIP. Patients who developed a hematoma requiring reoperation in the 30-day postoperative period were identified. Multivariate regressions were created to identify patient characteristics, operative variables, and subsequent complications that were associated with a postoperative hematoma requiring reoperation. Results: Among the 149,026 patients who underwent primary THA, 180 (0.12%) developed a postoperative hematoma requiring reoperation. Risk factors included body mass index (BMI) ≥ 35 (relative risk [RR]: 1.83, P = .011), American Society of Anesthesiologists (ASA) class ≥3 (RR: 2.11, P < .001), and history of bleeding disorder (RR: 2.71, P < .001). Associated intraoperative characteristics were an operative time ≥100 minutes (RR: 2.03, P < .001) and use of general anesthesia (RR: 1.41, P = .028). Patients developing a hematoma requiring reoperation were at higher risk of subsequent deep wound infection (RR: 21.57, P < .001), sepsis (RR: 4.3, P = .012), and pneumonia (RR: 3.69, P = .023). Conclusions: Surgical evacuation for a postoperative hematoma was performed in about 1 in 833 cases of primary THA. Several nonmodifiable and modifiable risk factors were identified. Given the 21.6 times increased risk of subsequent deep wound infection, select, at-risk patients may benefit from closer monitoring for signs of infection.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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