COPD as a risk factor of the complications in lower limb arthroplasty: a patient-matched study

Abstract

Purpose

A relevant proportion of patients undergoing joint replacement surgery for the treatment of osteoarthritis exhibit COPD. This coincidence may result from an increased prevalence of both the diseases in elderly patients. In this study, COPD, which is known to be associated with a variety of comorbidities, and its potential interactions, eg, mediated via systemic inflammation, are discussed. The purpose of the present study was to identify the role of COPD as an independent risk factor for complications after total knee and hip arthroplasty.

Patients and methods

In a monocentric patient cohort of 2,760 arthoplasties, propensity score matching was done using the following factors: sex, age, replaced joint, American Society of Anesthesiologists’ score, body mass index, hypertension, chronic heart disease, anticoagulation, diabetes mellitus, chronic renal deficiency, and actual smoking status to create 224 pairs. Both the pre-matched differences and the results after propensity score matching were statistically analyzed with p≤0.05 being defined as statistically significant.

Results

All confounders were eliminated after matching. Preoperatively measured C-reactive protein and leukocytes were higher in the COPD group (p<0.001; p=0.01, respectively). Intensive care unit admission was higher for COPD patients (p=0.023). Pneumonia occurred in patients with COPD only (p=0.024). There was a trend (not significant) toward a higher rate of wound infections, increased transfusion of red blood cells, and a prolonged hospital stay in patients with COPD.

Conclusion

COPD was associated with an increased length of hospital stay, a higher risk of pneumonia and wound infection, higher general complications, and an increased need for red blood cell transfusion. It is thus recommended to enhance the implementation of pneumonia prevention programs on surgical wards.

Keywords:

• COPD
• pneumonia
• arthroplasty
• complication
• transfusion
• comorbidity

Author contributions

Antonio Klasan and Patrick Schwarz contributed to data collection and created the first draft. Antonio Klasan performed data analysis. Peter Alter and Patrick Schwarz contributed to most of the revisions. All authors participated in conceptualizing the study, drafted the final article, approved the publication, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.