Systemic Lupus Erythematosus is a Risk Factor for Complications in Total Joint Arthroplasty
J. Joseph Gholson, MD, Brandon G. Wilkinson, MD, Timothy S. Brown, MD, Yubo Gao, PhD, S. Blake Dowdle, MD, and John J. Callaghan, MDHip Knee
Introduction
Systemic Lupus Erythematosus (SLE) has been associated with increased complications following hip and knee arthroplasty. The Purpose of this study was to determine the extent to which SLE is a risk factor in outcomes following total joint arthroplasty (TJA)
Methods
The nationwide inpatient sample was used to identify a cohort of 505,841 patients who had a total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2009-2011. Of these patients, 2,284 patients (0.45%) had been previously diagnosed with SLE. The impact of SLE on short-term TJA outcomes was determined using multivariate logistic regression. Differences in discharge destination and length of stay were also evaluated.
Results
SLE patients were more likely to have an all-cause medical complication, (OR 1.9, p<0.0001) and more likely to have an all-cause surgical complication (OR 1.3, p<0.0001). SLE patients were four times more likely to become septic in the post-operative period (OR 3.8, p<0.0487). SLE patients were more likely to have a genitourinary complication (OR 1.7, p<0.0001) and bleeding complications requiring transfusion (OR 2.1, p<0.0001). Patients with SLE also had an increased length of stay (0.38 days, p<0.0001) and increased probability of discharging to a facility (OR 2.1, p<0.0001).
Discussion
Patients with SLE had an increased rate of both medical and surgical all-cause complications. Patients were specifically found to be at higher risk for sepsis, genitourinary complications, and blood transfusions. Future risk adjustment models should include SLE as a contributor to medical and surgical complications in the postoperative period.
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