Impact of Valvular Heart Disease on Hip Replacement: A Retrospective Nationwide Inpatient Sample Database Study

BackgroundTo study the impact of valvular heart disease (VHD) on joint replacement, particularly the clinical impactions of aortic stenosis before total/partial hip arthroplasty. MethodsThis was a retrospective cohort study. Data on patients who had undergone joint replacement from 2005 to 2014 were extracted from the NIS database. Linear regression was used to analyze the essential characteristics of patients. Multivariate regression was used to estimate the correlation among demographics, comorbidities, complications, hospitalization costs, and time.ResultsOf the hip replacement surgeries, VHDs accounted for 5.56% and aortic stenosis (AS) accounted for 0.03% before surgery. VHD patients are related to the following characteristics: female patients (odds ratio [OR]=1.15 [1.12–1.18]), elective admission (OR=0.78 [0.76–0.80]), Charlson Comorbidity Index ≥3 (OR=1.06 [1.03–1.08]), large-volume hospitals (OR=1.13 [1.1–1.2]), teaching hospitals (OR=5 4.4 [2.9–6.7]), and hospital location in urban areas (OR=1.22 [1.2–1.3]). In addition, VHD is a risk factor for mortality and some acute postoperative medical complications, such as acute cardiac event (OR=2.96 [2.87–3.04]), acute pulmonary edema (OR=1.13 [1.06–1.21]), acute cerebrovascular event (OR=1.22 [1.16–1.74]), and acute renal failure (OR=1.22 [1.17–1.27]). It also has an impact on DVT/PE (OR=0.89 [0.8–0.99]). Patients with AS before hip replacement have basic demographic characteristics similar to those of TJA patients with valvular disease. Patients with AS are older (≥80 years) than those without AS before surgery (OR=3.28 [2.27–4.75) and have the following characteristics: female patients (OR=1.92 [1.32–2.8]) and elective admission (OR=0.51 [0.36–0.75]). The perioperative period is limited to acute postoperative complications, such as acute cardiac events (OR=2.50 [1.76–3.53]) and acute hepatic failure (OR=7.69 [1.8–32.89]). Both valvular diseases and AS are associated with a higher mortality rate and hospitalization cost. ConclusionValvular heart disease (VHD) independently predicted mortality rate and surgical and medical complications after total/partial hip arthroplasty.