Clinical Outcomes in Patients with Pulmonary Hypertension Undergoing Total Hip Arthroplasty

HSS Journal: Volume 10, Issue 2


David H. Kim, MD

David H. Kim, MD

Attending Anesthesiologist, Hospital for Special Surgery
Clinical Instructor in Anesthesiology, Weill Cornell Medical College

Kethy M. Jules-Elysee, MD

Kethy M. Jules-Elysee, MD

Assistant Attending Anesthesiologist, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

Lauren H. Turteltaub, MD

Lauren H. Turteltaub, MD

Assistant Attending Anesthesiologist, Hospital for Special Surgery
Clinical Assistant Professor of Anesthesiology, Weill Cornell Medical College

Michael K. Urban, MD, PhD

Michael K. Urban, MD, PhD

Associate Attending Anesthesiologist, Hospital for Special Surgery

Jacques T. Ya Deau, MD, PhD

Jacques T. Ya Deau, MD, PhD

Associate Attending Anesthesiologist, Hospital for Special Surgery
Clinical Associate Professor of Anesthesiology, Weill Cornell Medical College

Shane Reid, MD

Department of Anesthesiology, Hospital for Special Surgery

Stephen Lyman, MD

Department of Anesthesiology, Hospital for Special Surgery
Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College

Yan Ma, MD

Division of Biostatistics and Epidemiology, Department of Public Health, Weill Cornell Medical College

Abstract

Background
Pulmonary hypertension (PH) is regarded as a risk factor for perioperative complications in patients undergoing noncardiac surgery.

Questions/Purposes
The objective of this retrospective case–control study was to evaluate the adverse outcomes of pulmonary hypertension patients undergoing elective unilateral hip replacements.

Methods
We performed a retrospective case–control study of total hip replacement patients with pulmonary hypertension (cases) and without pulmonary hypertension (control). From the years 2003 to 2008, we identified a total of 132 patients undergoing primary total hip replacements with a diagnosis of pulmonary hypertension (right ventricular systolic pressure >35). The primary outcome assessed was the incidence of adverse events that occurred during the postoperative hospital stay. Secondary outcomes studied included length of hospital stay, mortality, and ability to reach certain physical therapy milestones.

Results
The PH group had significantly more adverse events than the control group. Nonlethal cardiac dysrhythmias comprised the most common adverse outcome among the PH group. Overall, the PH group had a morbidity rate of 34.7% while the control had a rate of 21%. The PH group had longer hospital stay (6.7 days vs. 5.9). Both groups had zero mortality during the hospital stay. The PH group had comparable rehabilitation recovery times than the control group.

Conclusion
This retrospective case–control study demonstrates that pulmonary hypertension patients undergoing total hip arthroplasty are more prone to adverse outcomes, especially cardiac dysrhythmias, and longer hospital stays.
Level of Evidence: Level III: Prognostic Study.

This article appears in HSS Journal: Volume 10, Issue 2
View the full HSS Journal Online First article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

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