Adverse Events After Total Hip Arthroplasty are not Sufficiently Characterized by 30-Day Follow-Up: A Database Study

Published:October 18, 2022DOI:



      Many previous studies of total hip arthroplasty (THA) have focused on adverse events occurring within 30 days of surgery. Studies examining 90-day postoperative adverse events have typically not focused on the timing of adverse events within that period. The current study evaluated the rate and timing of adverse events within 90 days of THA.


      Adult THA patients between 2010 and 2020 Q3 were identified from a large administrative dataset. Rates and timing of 90-day adverse events were determined. The median, interquartile range, and middle 80% were calculated based on the time of diagnosis for each adverse event. These were also dichotomized as occurring before or after 30 days and predictive factors for later adverse events were determined.


      Overall, 81,158 adverse events were noted, of which 56,500 (69.0%) were diagnosed within 30 days of surgery and 25,355 (31.0%) were diagnosed 31-90 days after surgery. The proportion of adverse events occurring 31-90 days after surgery ranged from 6% (transfusion) to 45% (wound dehiscence). Patients experiencing a later adverse event were more likely to be women and to have higher Elixhauser Comorbidity Index (ECI) scores.


      Almost one-third of adverse events following THA were diagnosed between postoperative days 31 and 90, highlighting the importance of looking beyond 30 days when estimating patients’ risk of postoperative adverse events. These data may inform future research, patient counseling, and prevention strategies.


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        • Arshi A.
        • Leong N.L.
        • Wang C.
        • Buser Z.
        • Wang J.C.
        • SooHoo N.F.
        Outpatient total hip arthroplasty in the United States: a population-based comparative analysis of complication rates.
        J Am Acad Orthop Surg. 2019; 27: 61-67
        • Nelson S.J.
        • Webb M.L.
        • Lukasiewicz A.M.
        • Varthi A.G.
        • Samuel A.M.
        • Grauer J.N.
        Is outpatient total hip arthroplasty safe?.
        J Arthroplasty. 2017; 32: 1439-1442
        • Jolback P.
        • Rolfson O.
        • Cnudde P.
        • Odin D.
        • Malchau H.
        • Lindahl H.
        • et al.
        High annual surgeon volume reduces the risk of adverse events following primary total hip arthroplasty: a registry-based study of 12,100 cases in Western Sweden.
        Acta Orthop. 2019; 90: 153-158
        • Ravi B.
        • Jenkinson R.
        • Austin P.C.
        • Croxford R.
        • Wasserstein D.
        • Escott B.
        • et al.
        Relation between surgeon volume and risk of complications after total hip arthroplasty: propensity score matched cohort study.
        BMJ. 2014; 348: g3284
        • Illingworth K.D.
        • Mihalko W.M.
        • Parvizi J.
        • Sculco T.
        • McArthur B.
        • el Bitar Y.
        • et al.
        How to minimize infection and thereby maximize patient outcomes in total joint arthroplasty: a multicenter approach: AAOS exhibit selection.
        J Bone Joint Surg Am. 2013; 95: e50
        • Malpani R.
        • McLynn R.P.
        • Bovonratwet P.
        • Bagi P.S.
        • Yurter A.
        • Mercier M.R.
        • et al.
        Coagulopathies are a risk factor for adverse events following total hip and total knee arthroplasty.
        Orthopedics. 2020; 43: 233-238
        • Ondeck N.T.
        • Fu M.C.
        • McLynn R.P.
        • Bovonratwet P.
        • Malpani R.
        • Grauer J.N.
        Preoperative laboratory testing for total hip arthroplasty: unnecessary tests or a helpful prognosticator.
        J Orthop Sci. 2020; 25: 854-860
        • Kebaish K.J.
        • Puvanesarajah V.
        • Rao S.
        • Zhang B.
        • Ottesen T.D.
        • Grauer J.N.
        • et al.
        Diabetes status affects odds of body mass index-dependent adverse outcomes after total hip arthroplasty.
        J Am Acad Orthop Surg. 2021; 29: 71-77
        • Cram P.
        • Hawker G.
        • Matelski J.
        • Ravi B.
        • Pugely A.
        • Gandhi R.
        • et al.
        Disparities in knee and hip arthroplasty outcomes: an observational analysis of the ACS-NSQIP clinical registry.
        J Racial Ethn Health Disparities. 2018; 5: 151-161
        • Bohl D.D.
        • Fu M.C.
        • Golinvaux N.S.
        • Basques B.A.
        • Gruskay J.A.
        • Grauer J.N.
        The “July effect” in primary total hip and knee arthroplasty: analysis of 21,434 cases from the ACS-NSQIP database.
        J Arthroplasty. 2014; 29: 1332-1338
        • Hart A.
        • Khalil J.A.
        • Carli A.
        • Huk O.
        • Zukor D.
        • Antoniou J.
        Blood transfusion in primary total hip and knee arthroplasty. Incidence, risk factors, and thirty-day complication rates.
        J Bone Joint Surg Am. 2014; 96: 1945-1951
        • Pugely A.J.
        • Callaghan J.J.
        • Martin C.T.
        • Cram P.
        • Gao Y.
        Incidence of and risk factors for 30-day readmission following elective primary total joint arthroplasty: analysis from the ACS-NSQIP.
        J Arthroplasty. 2013; 28: 1499-1504
        • Basques B.A.
        • Toy J.O.
        • Bohl D.D.
        • Golinvaux N.S.
        • Grauer J.N.
        General compared with spinal anesthesia for total hip arthroplasty.
        J Bone Joint Surg Am. 2015; 97: 455-461
        • Haynes M.S.
        • Alder K.D.
        • Bellamkonda K.
        • Kuzomunhu L.
        • Grauer J.N.
        Incidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty.
        PLoS One. 2020; 15: e0239239
        • Bovonratwet P.
        • Bohl D.D.
        • Malpani R.
        • Nam D.
        • Della Valle C.J.
        • Grauer J.N.
        Incidence, risk factors, and impact of Clostridium difficile colitis following primary total hip and knee arthroplasty.
        J Arthroplasty. 2018; 33: 205-210.e1
        • Pathak N.
        • Kahlenberg C.A.
        • Moore H.G.
        • Sculco P.K.
        • Grauer J.N.
        Thirty-day readmissions after aseptic revision total hip arthroplasty: rates, predictors, and reasons vary by surgical indication.
        J Arthroplasty. 2020; 35: 3673-3678
        • Shultz B.N.
        • Galivanche A.R.
        • Ottesen T.D.
        • Bovonratwet P.
        • Grauer J.N.
        The use of older versus newer data in the national surgical quality improvement program database influences the results of total hip arthroplasty outcomes studies.
        J Am Acad Orthop Surg Glob Res Rev. 2019; 3: e19.00108
        • Bohl D.D.
        • Ondeck N.T.
        • Basques B.A.
        • Levine B.R.
        • Grauer J.N.
        What is the timing of general health adverse events that occur after total joint arthroplasty?.
        Clin Orthop Relat Res. 2017; 475: 2952-2959
        • Gagnier J.J.
        • Morgenstern H.
        • Kellam P.
        A retrospective cohort study of adverse events in patients undergoing orthopaedic surgery.
        Patient Saf Surg. 2017; 11: 15
        • Saucedo J.M.
        • Marecek G.S.
        • Wanke T.R.
        • Lee J.
        • Stulberg S.D.
        • Puri L.
        Understanding readmission after primary total hip and knee arthroplasty: who's at risk?.
        J Arthroplasty. 2014; 29: 256-260
        • Klein G.R.
        • Posner J.M.
        • Levine H.B.
        • Hartzband M.A.
        Same day total hip arthroplasty performed at an ambulatory surgical center: 90-day complication rate on 549 patients.
        J Arthroplasty. 2017; 32: 1103-1106
        • Services CfMM
        Comprehensive care for joint replacement model.
        ([accessed 04.10.22])
        • Elixhauser A.
        • Steiner C.
        • Harris D.R.
        • Coffey R.M.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Kammien A.J.
        • Zhu J.R.
        • Gillinov S.M.
        • Gouzoulis M.J.
        • Grauer J.N.
        Adverse events after posterior lumbar fusion are not sufficiently characterized with 30-day follow-up: a database study.
        J Am Acad Orthop Surg. 2022; 30: 528-533
        • Koenig K.
        • Huddleston 3rd, J.I.
        • Huddleston H.
        • Maloney W.J.
        • Goodman S.B.
        Advanced age and comorbidity increase the risk for adverse events after revision total hip arthroplasty.
        J Arthroplasty. 2012; 27: 1402-1407.e1
        • Soohoo N.F.
        • Farng E.
        • Lieberman J.R.
        • Chambers L.
        • Zingmond D.S.
        Factors that predict short-term complication rates after total hip arthroplasty.
        Clin Orthop Relat Res. 2010; 468: 2363-2371
        • Basques B.A.
        • Bell J.A.
        • Sershon R.A.
        • Della Valle C.J.
        The influence of patient gender on morbidity following total hip or total knee arthroplasty.
        J Arthroplasty. 2018; 33: 345-349
        • Ondeck N.T.
        • Bohl D.D.
        • Bovonratwet P.
        • Anandasivam N.S.
        • Cui J.J.
        • McLynn R.P.
        • et al.
        Predicting adverse outcomes after total hip arthroplasty: a comparison of demographics, the American society of anesthesiologists class, the modified Charlson comorbidity index, and the modified frailty Index.
        J Am Acad Orthop Surg. 2018; 26: 735-743
        • Ondeck N.T.
        • Bovonratwet P.
        • Ibe I.K.
        • Bohl D.D.
        • McLynn R.P.
        • Cui J.J.
        • et al.
        Discriminative ability for adverse outcomes after surgical management of hip fractures: a comparison of the Charlson comorbidity index, elixhauser comorbidity measure, and modified frailty index.
        J Orthop Trauma. 2018; 32: 231-237