The impact of long-term aspirin use on patients undergoing total hip arthroplasty

Q: What are the key findings of this study?

Long-term aspirin use was associated with higher odds of any perioperative complication (aOR 1.182, 95% CI 1.146-1.219) and myocardial infarction (aOR 2.147) in total hip arthroplasty.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Total hip arthroplasty (THA) (n=310925). Intervention: Long-term aspirin use (ICD-10-CM code Z79.82) vs. Matched non-long-term aspirin use. Primary outcome: Any perioperative in-hospital complication (OR 1.182, 95% CI 1.146-1.219, p=<0.001).

Q: What does this research mean for the field?

Pre-existing long-term aspirin use in patients undergoing total hip arthroplasty is associated with higher odds of overall perioperative complications, acute myocardial infarction, and acute cerebrovascular disease, but lower odds of septicemia and respiratory failure. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the association between pre-existing long-term aspirin use and perioperative complications as well as resource consumption among patients undergoing total hip arthroplasty.

Chaojun Wang; Rong Gu; Liang Chen; Yusong Zhang; Jian Wang; Yuxin Zhong; Yuhang Chen; Qinfeng Yang; Lin Yang; Jihuang Huang

doi:10.1186/s13741-026-00756-4

October 21, 2026Perioperative MedicineOpen Access

The impact of long-term aspirin use on patients undergoing total hip arthroplasty

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Key result

Long-term aspirin linked to ~18% higher odds of perioperative complications in total hip arthroplasty.

OR 1.182
95% CI 1.146-1.219
P<0.001
n=310,925

Why the study?

With growing demand for total hip arthroplasty and substantially increased aspirin use, the study aimed to explore the influence of long-term aspirin use on perioperative complications in patients undergoing total hip arthroplasty.

Does pre-existing long-term aspirin use influence the risk of perioperative in-hospital complications and resource consumption in adult patients undergoing elective primary total hip arthroplasty?

Key Points

To investigate the association between pre-existing long-term aspirin use and perioperative complications as well as resource consumption among patients undergoing total hip arthroplasty.
Queried the National Inpatient Sample database for patients undergoing primary total hip arthroplasty between 2019 and 2022 (analytic sample N=310,925).
Applied 1:1 propensity score matching to balance baseline demographics and comorbidities, yielding 49,613 patients in the long-term aspirin use cohort and 49,613 matched controls.
Evaluated perioperative complications and hospital resource utilization using multivariable logistic regression, chi-square tests, t-tests, and rank sum tests.
The proportion of patients with coded long-term aspirin use increased from 12.13% in 2019 to 18.21% in 2022.
After multivariable adjustment, long-term aspirin use was associated with higher risks of any complication (adjusted OR 1.182, 95% CI 1.146–1.219, p<0.001), acute myocardial infarction (adjusted OR 2.147, 95% CI 2.018–2.284, p<0.001), and acute cerebrovascular disease (adjusted OR 1.993, 95% CI 1.693–2.344, p<0.001).
Long-term aspirin use was significantly associated with lower odds of septicemia (adjusted OR 0.457, 95% CI 0.300–0.694, p<0.001), respiratory failure (adjusted OR 0.730, 95% CI 0.594–0.897, p=0.003), and prolonged hospital stay (adjusted OR 0.829, 95% CI 0.806–0.853, p<0.001).

Study Design

Type

Cohort (n=310,925)

Multicenter

Yes

Structured PICO

Does pre-existing long-term aspirin use influence the risk of perioperative in-hospital complications and resource consumption in adult patients undergoing elective primary total hip arthroplasty?

P

Population

310,925 adult patients (99,226 after 1:1 propensity score matching; ~51.5% female, mean age 65-68 years) undergoing elective primary total hip arthroplasty in the United States, excluding users of long-term anticoagulants or other antiplatelet agents, followed during the index hospitalization.

E

Exposure

Long-term aspirin use (L-AU), defined by ICD-10-CM code Z79.82 (long-term current use of aspirin; dose, duration, adherence, indication, and perioperative discontinuation/resumption timing not captured).

C

Comparator

No long-term aspirin use (non-L-AU cohort, both whole cohort n=261,312 and 1:1 propensity score-matched cohort n=49,613 matched on demographics, hospital characteristics, Charlson comorbidity index, and Elixhauser comorbidities).

O

Outcome

Perioperative in-hospital complications (from admission to discharge during the index hospitalization), including 'any complication' (composite of at least one prespecified complication: wound rupture, wound infection, urinary tract infection, acute renal failure, thrombocytopenia, acute postoperative pain, septicemia, cardiac arrest, pneumonia, postoperative shock, twitch, deep vein thrombosis, pulmonary embolism, blood transfusion, ecchymosis, acute myocardial infarction, hemorrhage/hematoma/seroma, postoperative delirium, acute cerebrovascular disease, gastrointestinal bleeding, retention of urine, respiratory failure, or death).composite

Main Result

Odds Ratio: 1.182 (95% CI 1.146–1.219)

Absolute Event Rate: 23.85% vs 20.94%

p-value: p=<0.001

In a large US inpatient cohort undergoing elective total hip arthroplasty, pre-existing long-term aspirin use was associated with higher in-hospital odds of acute myocardial infarction and cerebrovascular disease, but lower odds of septicemia, respiratory failure, acute renal failure, and prolonged hospital stay.

Limitations

Retrospective administrative database design using ICD-10 billing codes, which may lead to misclassification or inability to distinguish pre-existing conditions from new postoperative events
Lack of granular data on aspirin dose, duration, adherence, indication, and timing of perioperative discontinuation or resumption
Unweighted NIS sample analyzed without survey stratification or hospital-level clustering adjustments, limiting national representativeness
No formal statistical adjustment for multiple comparisons across numerous evaluated outcomes
Absence of key perioperative clinical variables including surgical approach, anesthesia type, tranexamic acid use, thromboprophylaxis regimens, and post-discharge outcomes
Retrospective administrative claims database analysis does not establish causality.
ICD-10-CM code Z79.82 does not capture aspirin dose, duration, adherence, specific indication (primary vs. secondary prevention), or timing of perioperative continuation, discontinuation, and resumption.
Present-on-admission indicators were not used to distinguish pre-existing conditions from newly developed in-hospital events.
Potential residual confounding by indication, as underlying clinician-assessed cardiovascular risk and frailty were not characterized.
No formal adjustment for multiple comparisons was performed across multiple evaluated in-hospital outcomes.
Analyses were based on the unweighted NIS sample without survey stratification or hospital-level clustering adjustment.

Implication

Associated with higher perioperative MI risk after hip arthroplasty; hypothesis-generating and should not yet change practice.

Abstract

Due to the aging population and the high incidence of osteoarticular diseases, the demand for the future development of total hip arthroplasty (THA). Aspirin use has increased substantially owing to its multiple benefits. The aim of our study was to explore the influence of Long-Aspirin Use (L-AU) on perioperative complications in patients undergoing THA. By querying the National Inpatient Sample (NIS) database, the data of patients undergoing THA from 2019 to 2022 were acquired after removing irrelevant data. Propensity score matching (PSM) was designed to reduce the impact of demographic and comorbidity characteristics on perioperative complications. T Test , Chi-Square Test, Rank Sum Test, as well as logistic regression analysis, were used for perioperative complications risk analysis and resource consumption analysis. The proportion of ICD-coded long-term aspirin use (L-AU) among patients undergoing total hip arthroplasty in the unweighted NIS analytic sample increased from 12.13% to 18.21% between 2019 and 2022. After multivariable adjustment, L‑AU was significantly associated with elevated risks of any complication, acute myocardial infarction, and acute cerebrovascular disease. Meanwhile, L‑AU was significantly associated with reduced odds of septicemia and respiratory failure, as well as lower odds of prolonged length of stay and lower total hospital costs. No statistically significant associations were observed between L‑AU and most other perioperative complications. In this retrospective analysis, long-term aspirin use was associated with selected in-hospital outcomes among patients undergoing THA, including lower odds of septicemia and respiratory failure and higher odds of acute myocardial infarction and acute cerebrovascular disease. These associations do not establish causality, and the effects of perioperative aspirin continuation, discontinuation, or resumption could not be assessed. Prospective studies with detailed medication and clinical data are needed to clarify the perioperative risks and benefits of aspirin management in this population. This shows that a total of 369,846 patients undergoing primary THA between 2019 and 2022, through exclusion of inappropriate samples among them, obtained the remaining 310,925 patients who were classified into the long-term aspirin use (L-AU) cohort (n=49,613) and matched non-L-AU cohort (n=49,613) after propensity score matching analysis.

Discussion

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Cite This Study

Wang et al. (2026) conducted a cohort in Total hip arthroplasty (THA) (n=310,925). Long-term aspirin use (ICD-10-CM code Z79.82) vs. Matched non-long-term aspirin use was evaluated on Any perioperative in-hospital complication (OR 1.182, 95% CI 1.146-1.219, p=<0.001). Long-term aspirin use was associated with higher odds of any perioperative complication (aOR 1.182, 95% CI 1.146-1.219) and myocardial infarction (aOR 2.147) in total hip arthroplasty.

synapsesocial.com/papers/6ad9e562f67b53d0945659c2 https://doi.org/10.1186/s13741-026-00756-4

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The impact of long-term aspirin use on patients undergoing total hip arthroplasty

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The impact of long-term aspirin use on patients undergoing total hip arthroplasty

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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