Advertisement

Surgical complications associated with congestive heart failure in elderly patients following primary hip hemiarthroplasty for femoral neck fractures

  • Ryan Lee
  • Danny Lee
  • Nikhil B. Gowda
  • William V. Probasco
  • George Ibrahim
  • David P. Falk
  • Rajeev PandarinathEmail author
Original Article • HIP - ARTHROPLASTY
  • 94 Downloads

Abstract

Introduction

Although there are reports of the impact of congestive heart failure (CHF) on total knee arthroplasty and total hip arthroplasty, there is a lack of literature analyzing CHF in hip hemiarthroplasty (HHA) procedures. The main objective of this study was to evaluate the effect of CHF on risks for complications following HHA for the treatment of FNF.

Methods

The ACS-NSQIP database was queried for all patients who had undergone HHA from 2005 to 2016. Patients were propensity-matched without replacement in a 1:1 manner based on age and gender. Pearson’s Chi squared tests and Fischer’s exact tests were utilized to compare differences in demographics, comorbidities, and complication rates. Multivariate logistic regression analyses were used to assess the impact of CHF as an independent risk factor for postoperative complications.

Results

A propensity-matched cohort of 537 (4.24%) non-CHF patients was generated in order to analyze differences between the two cohorts. CHF was found to be a significant independent risk factor for pneumonia (p = 0.003), progressive renal insufficiency (p = 0.040), myocardial infarctions (p = 0.050), extended length of stay (≥ 5 days) (p < 0.001), and mortality (p < 0.001).

Conclusion

This study has established CHF as an independent risk factor for various postoperative complications following HHA for the treatment of FNF. Although orthopedic surgeons may decline to perform elective procedures on CHF patients, FNFs require urgent surgical intervention. Therefore, it is important to be aware of various increased risks of certain complications in this subset patient population.

Keywords

Congestive heart failure Hip hemiarthroplasty Complications Pneumonia Mortality 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Coronel R, de Groot JR, van Lieshout JJ (2001) Defining heart failure. Cardiovasc Res 50:419–422CrossRefGoogle Scholar
  2. 2.
    Tan LB, Williams SG, Tan DK, Cohen-Solal A (2010) So many definitions of heart failure: are they all universally valid? A critical appraisal. Expert Rev Cardiovasc Ther 8:217–228CrossRefGoogle Scholar
  3. 3.
    Inamdar AA, Inamdar AC (2016) Heart failure: diagnosis, management and utilization. J Clin Med 5:62CrossRefGoogle Scholar
  4. 4.
    Yancy CW, Jessup M, Bozkurt B et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147–e239CrossRefGoogle Scholar
  5. 5.
    Pazos-Lopez P, Peteiro-Vazquez J, Carcia-Campos A, Garcia-Bueno L, de Torres JPA, Castro-Beiras A (2011) The causes, consequences, and treatment of left or right heart failure. Vasc Health Risk Manag 7:237–254Google Scholar
  6. 6.
    Savarese G, Lund LH (2017) Global public health burden of heart failure. Card Fail Rev 3:7–11CrossRefGoogle Scholar
  7. 7.
    Writing Group Members, Mozaffarian D, Benjamin EJ et al (2016) American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 133:e38–e360Google Scholar
  8. 8.
    Salem KM, Shannak OA, Scammell BE, Moran CG (2014) Predictors and outcomes of treatment in hip hemiarthroplasty dislocation. Ann R Coll Surg Engl 96:446–451CrossRefGoogle Scholar
  9. 9.
    Currie C, Partridge M, Plant F, Roberts J, Wakeman R, Williams A (2011) The National Hip Fracture Database National Report 2011. NHFD, London. https://www.nhfd.co.uk/003/hipfracturer.nsf/NHFDNationalReport2011_Final.pdf. Accessed 5 May 2018
  10. 10.
    Curtis GL, Newman JM, George J et al (2018) Perioperative outcomes and complications in patients with heart failure following total knee arthroplasty. J Arthroplasty 33:36–40CrossRefGoogle Scholar
  11. 11.
    Curtis G, George J, Newman JM et al (2017) Heart failure and total hip arthroplasty: what are the perioperative outcomes and complications? J Hip Surg 01:140–145CrossRefGoogle Scholar
  12. 12.
    American College of Surgeons National Surgical Quality Improvement Program. User Guide for the 2016 ACS NSQIP Participant Use Data File (PUF). https://www.facs.org/~/media/files/quality%20programs/nsqip/nsqip_puf_userguide_2016.ashx. Accessed 5 May 2018
  13. 13.
    American College of Surgeons National Surgical Quality Improvement Program (2013) User Guide for the 2012 ACS NSQIP Participant Use Data File (PUF). https://www.facs.org/~/media/files/quality%20programs/nsqip/ug12.ash. Accessed 5 May 2018
  14. 14.
    Lewis TC, Cortes J, Altshuler D, Papadopoulos J (2018) Venous thromboembolism prophylaxis: a narrative review with a focus on the high-risk critically ill patient. J Intensive Care Med.  https://doi.org/10.1177/0885066618796486 Google Scholar
  15. 15.
    Missios S, Bekelis K (2015) Hospitalization cost after spine surgery in the United States of America. J Clin Neurosci 22:1632–1637CrossRefGoogle Scholar
  16. 16.
    Hernandez AF, Whellan DJ, Stroud S, Sun JL, O’Connor CM, Jollis JG (2004) Outcomes in heart failure patients after major noncardiac surgery. J Am Coll Cardiol 44:1446–1453CrossRefGoogle Scholar
  17. 17.
    Menendez ME, Baker DK, Fryberger CT, Ponce BA (2015) Predictors of extended length of stay after elective shoulder arthroplasty. J Shoulder Elbow Surg 24:1527–1533CrossRefGoogle Scholar
  18. 18.
    Joseph GJ, Noiseux NO, Otero JE, Gao Y, Shah AS (2017) Patient factors systematically influence hospital length of stay in common orthopaedic procedures. Iowa Orthop J 37:233–237Google Scholar
  19. 19.
    Higuera CA, Elsharkawy K, Klika AK, Brocone M, Barsoum WK (2011) 2010 mid-america orthopaedic association physician in training award: Predictors of early adverse outcomes after knee and hip arthroplasty in geriatric patients. Clin Orthop Relat Res 469:1391–1400CrossRefGoogle Scholar
  20. 20.
    Bohl DD, Sershon RA, Saltzman BM, Darrith B, Della Valle CJ (2018) Incidence, risk factors, and clinical implications of pneumonia after surgery for geriatric hip fracture. J Arthroplasty 33:1552–1556CrossRefGoogle Scholar
  21. 21.
    Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the united states from 1979 through 2000. N Engl J Med 348:1546–1554CrossRefGoogle Scholar
  22. 22.
    Basilico FC, Sweeney G, Losina E et al (2008) Risk factors for cardiovascular complications following total joint replacement surgery. Arthritis Rheum 58:1915–1920CrossRefGoogle Scholar
  23. 23.
    Silverberg D, Wexler D, Blum M, Schwartz D, Iaina A (2004) The association between congestive heart failure and chronic renal disease. Curr Opin Nephrol Hypertens 13:163–170CrossRefGoogle Scholar
  24. 24.
    Waldum B, Westheim AS, Sandvik L et al (2010) Renal function in outpatients with chronic heart failure. J Card Fail 16:374–380CrossRefGoogle Scholar
  25. 25.
    Al-Naher A, Wright D, Devonald MAJ, Pirmohamed M (2018) Renal function monitoring in heart failure—what is the optimal frequency? A narrative review. Br J Clin Pharmacol 84:5–17CrossRefGoogle Scholar
  26. 26.
    Kimmel LA, Wilson S, Janardan JD, Liew SM, Walker RG (2014) Incidence of acute kidney injury following total joint arthroplasty: a retrospective review by RIFLE criteria. Clin Kidney J 7:546–551CrossRefGoogle Scholar
  27. 27.
    Ferguson KB, Winter A, Russo L et al (2017) Acute kidney injury following primary hip and knee arthroplasty surgery. Ann R Coll Surg Engl 99:307–312CrossRefGoogle Scholar
  28. 28.
    Kateros K, Doulgerakis C, Galanakos SP, Sakellariou VI, Papadakis SA, Macheras GA (2013) Analysis of kidney dysfunction in orthopaedic patients. BMC Nephrol 13:101CrossRefGoogle Scholar
  29. 29.
    Rhee C, Lethbridge L, Richardson G, Dunbar M (2018) Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg 61:165–176CrossRefGoogle Scholar
  30. 30.
    Upshaw K, Kiernan MS (2013) Preoperative cardiac risk assessment for noncardiac surgery in patients with heart failure. Curr Heart Fail Rep 10:147–156CrossRefGoogle Scholar
  31. 31.
    Healy KO, Waksmonski CA, Altman RK, Stetson PD, Reyentovich A, Maurer MS (2010) Perioperative outcome and long-term mortality for heart failure patients undergoing intermediate- and high-risk noncardiac surgery: impact of left ventricular ejection fraction. Congesi Heart Fail 16:45–49CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.The George Washington University School of Medicine and Health SciencesThe George Washington UniversityWashingtonUSA
  2. 2.Department of Orthopaedic SurgeryThe George Washington UniversityWashingtonUSA
  3. 3.Department of Orthopaedic SurgeryHospital of the University of PennsylvaniaPhiladelphiaUSA

Personalised recommendations