Risk score for major complications after total hip arthroplasty: The beneficial effect of neuraxial anesthesia. A retrospective observational study

Background:Total hip arthroplasty (THA) is an effective treatment for symptomatic osteoarthritis after failed nonsurgical therapies. Minimizing perioperative complications is critical for faster recovery and shorter hospital stay. The primary aim of this study was to identify predictors of perioperative major complications (MC) and mortality after THA, and to use these predictors to develop a risk scoring system.Methods:The 2006-2016 National Surgical Quality Improvement Program (NSQIP) database was queried for adult patients who underwent primary elective THA performed under general or neuraxial anesthesia. Univariate and multivariate logistic regression and bootstrap analyses were used to select the strongest predictors for MC. A simple risk score was created based on the beta estimates for the selected predictors.Results:Included were 104,404 cases. The final model had five predictors for MC: age ≥65 yr, congestive heart failure, hypertension, creatinine ≥2 mg/dL, and diabetes mellitus. The model had a fair discrimination ability with an area under the curve (AUC) value of 0.67 on the training sample and 0.65 on the test sample. The model had good calibration for the data in both the training and test samples. Neuraxial anesthesia decreased the risk of MC (OR 0.54 [95% CL, 0.44-0.66], P<0.0001). Risk scores for MC ranged from 0 to 13. A risk score of 4 or greater was associated with a significant increase in MC.Conclusions:Neuraxial anesthesia is associated with decreased risk of MC after THA. The risk model developed may assist with preoperative decision-making regarding the choice of anesthesia, selection of outpatient cases, and postoperative care.Level of Evidence:Level III.