Total Joint Arthroplasty Outcomes in Patients With a Previously Failed Toxicology Screen: A Propensity Score–Matched Analysis

The purpose of this study is to review the outcomes of a consecutive series of arthroplasty patients who had previously failed a urine toxicology test. Specifically, we assessed (1) mortality at last follow-up; (2) 90-day readmission and reoperation; (3) rate of complications; and (4) hospital length of stay (LOS) and rates of nonhome discharge.

A single-institution, electronic medical record database was queried for primary arthroplasty patients from 2006 to 2017 who had previously failed a day-of-arthroplasty urine toxicology screen. Patients were matched in a 2:1 ratio with toxicology-negative controls.

The mortality rate among toxicology-positive THA patients was 1 of 20 (5%) compared to 0 of 40 among controls ( P = .333); the rate of readmission was 3 of 20 (15%) vs 0 of 40 ( P = .033); the rate of reoperation was 1 of 20 vs 0 of 40 ( P = .333); the rate of surgical complications was 6 of 20 (30%) vs 1 of 40 (2.5%) ( P = .004); the rate of medical complication was 4 of 20 (20%) vs 1 of 40 (2.5%) ( P = .038); the average LOS was 4 days (range, 1-8 days) vs 2 days (range, 1-10) ( P = .002); and the rate of nonhome discharge was 5 of 20 (25%) vs 2 of 40 (5%) patients in the control group ( P = .013). The mortality rate among toxicology-positive TKA patients was 1 of 19 (5.3%) compared to 0 of 38 among controls ( P = .333); the rate of readmission was 5 of 19 (26.3%) vs 2 of 39 (5.3%) ( P = .033); the rate of reoperation was 3 of 19 (15.8%) vs zero ( P = .033); the rate of surgical complications was 4 of 21 (21.1%) vs 1 of 38 (2.6%) ( P = .038); the rate of medical complications was 5 of 19 (26.3%) vs 2 of 38 (5.3%) ( P = .035); the average LOS was 4 days (range, 2-6 days) vs 2 days (range, 1-8 days) ( P = .001), the rate of nonhome discharge was 7 of 19 (36.8%) compared to 2 of 38 (5.3%) in the control group ( P = .004).

These results suggest that toxicology-positive patients require a careful discussion of goals of care before undertaking total hip arthroplasty or total knee arthroplasty.