Total Hip Arthroplasty in Patients with Sickle Cell Disease: A National Database Study

Background:

The purpose of this study is to analyze the peri and postoperative outcomes in patients with sickle cell disease undergoing total hip arthroplasty (THA) compared to the general population.

Methods:

In this retrospective study using the National Inpatient Sample (NIS) Database, 367,890 patients who underwent THA were identified of which 655 had sickle cell disease (SCD). We used ICD-10 codes to assess postoperative variables including Length of stay, cost of care, and medical and surgical complications in patients with SCD compared to patients without SCD.

Results:

A comparison of the demographic variables showed that age at admission varied significantly between patients with SCD (46.43 years; SD 16.3) and patients without SCD (65.89 years; SD 11.3) (p <0.01). Length of stay (3.55 days; SD 4.4 vs 2.32 days; SD 2.5) and hospitalization charges ($76623.10; SD 59789.119 vs $66862.57; SD 47816.860) were higher in the SCD group compared to control group. The odds of developing medical complications like blood loss anemia (1.341, CI of 1.1 - 1.6, p <0.01), need for blood transfusions (5.903, CI 4.823-7.225, p <0.01) and acute renal failure (1.626, CI of 1.09 - 2.4, p 0.014) were higher in the SCD group compared to control group. Risk of periprosthetic infections (odds ratio of 2.693; CI of 1.6 - 4.3, p <0.01) was also significantly elevated in the SCD group. There was no difference between the two groups in regards to other medical or surgical complications postoperatively.

Conclusion:

Patients with SCD undergo THA at an earlier age, length of stay and hospitalization charges are higher in patients with SCD. Postoperatively they experience a higher incidence of blood loss anemia necessitating blood transfusion and acute renal failure. The risk of periprosthetic infection was also higher in patients with SCD.

No relevant conflicts of interest to declare.