Effects of Dementia on Adverse Outcomes in Geriatric Patients Undergoing Elective Total Hip Arthroplasty: Analysis of the US Nationwide Inpatient Sample.

Abstract

Total hip arthroplasty (THA) significantly improves the quality of life of patients with end-stage osteoarthritis. Dementia, which is prevalent in geriatric THA recipients, is correlated with several adverse outcomes. This study further investigated the impact of dementia on perioperative outcomes (complications, mortality, skilled nursing facilities [SNFs] transfer, total cost, and length of hospital stay [LOS]) in geriatric patients undergoing elective THA. This study retrospectively analysed data from patients aged 65 years and older who underwent elective THA in the Nationwide inpatient sample (NIS) database from 2010 to 2019. Propensity score matching (PSM) was applied to reduce potential selection bias arising from differences in demographic and comorbidity factors. The Wilcoxon rank test (for continuous data) and Chi‒square test (for categorical data) were used to assess demographic characteristics, comorbidities, LOS, total hospital costs, and in-hospital mortality; logistic regression analysis was employed to determine the influence of dementia on adverse outcomes. 376 323 elective geriatric THA patient samples from the NIS database were included, with an overall dementia prevalence of 2.05%. Adverse outcomes following elective THA in patients with dementia included deep vein thrombosis, acute myocardial infarction, acute anaemia, cardiac arrest, urinary retention, urinary tract infection, acute renal failure, pneumonia, respiratory failure, invasive mechanical ventilation, postoperative delirium, gastrointestinal bleeding, mechanical loosening, broken internal joint prosthesis, dislocation, other prosthesis-related complications, wound rupture/unhealed, transfusion, prolonged LOS, increased total cost, and discharge to SNFs. In elective geriatric THA patients, dementia is independently associated with significantly higher risks of perioperative complications and greater healthcare resource utilization, underscoring the need for enhanced perioperative monitoring and multidisciplinary care for this vulnerable group.