Original Article
Complications and Survival Analyses of Hip Arthroscopies Performed in the National Health Service in England: A Review of 6,395 Cases

https://doi.org/10.1016/j.arthro.2014.12.013Get rights and content

Purpose

Our study aimed to identify the complications of hip arthroscopies with particular emphasis on the 30-day readmission rate; 90-day deep vein thrombosis (DVT) and pulmonary embolism (PE) rate and mortality rate; revision hip arthroscopy rate; and in particular, survivorship with conversion to total hip replacement (THR) as the endpoint.

Methods

The records of patients undergoing hip arthroscopy were extracted from the administrative hospital admissions database covering all admissions to the National Health Service hospitals in England using ICD-10 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision) and OPCS-4 (Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, fourth revision) codes.

Results

A total of 6,395 hip arthroscopies were included in the study period. The 30-day readmission rate was 0.5%; both the 90-day DVT rate and PE rate were 0.08%; and the 90-day mortality rate was 0.02%. THR was performed in 680 patients (10.6%) at a mean of 1.4 years after the index operation, and 286 patients (4.5%) underwent revision hip arthroscopy at a mean of 1.7 years. Kaplan-Meier survival analysis showed an 8-year survival rate of 82.6% (95% confidence interval [CI], 80.9% to 84.2%), whereas Cox proportional hazard analysis adjusting for age, gender, and Charlson comorbidity score showed an 8-year survival rate of 86%. Female patients had a 1.68 times (95% CI, 1.41 to 2.01) higher risk of conversion to THR than male patients, and patients aged 50 years or older had a 4.65 (95% CI, 3.93 to 5.49) times higher risk of requiring hip replacement than patients younger than 50 years.

Conclusions

In this large series of 6,395 hip arthroscopies looking at the national data from the English National Health Service, our null hypothesis has been supported, and we have determined that the rate of short-term complications, in particular the risk of DVT and PE after this operation, is low. Higher age and female gender are significant predictors of conversion to THR, with Cox proportional hazard analyses showing a survivorship rate of 86% at 8 years after adjustment for confounding variables.

Level of Evidence

Level IV, therapeutic case series.

Section snippets

Methods

We extracted records of patients undergoing hip arthroscopy from the administrative hospital admissions database (Hospital Episode Statistics). The Hospital Episode Statistics database covers all admissions to English hospitals providing care for National Health Service (NHS) patients and includes diagnosis (coded using ICD-10 [International Statistical Classification of Diseases and Related Health Problems, 10th Revision] codes) and surgical procedure fields (coded using OPCS-4 [Office of

Results

A total of 6,395 hip arthroscopies performed in the English NHS from April 1, 2005, to January 31, 2013, were included in the study from a total of 7,280 procedures. Patients with incomplete datasets were excluded. Bilateral cases were treated as individual episodes. Table 1 shows the demographic data. The mean age of the patients was 38 years (range, 11 to 83 years); the majority of patients were female patients (2,381 male patients v 4,014 patients), with a male-female ratio of 1:1.7. The

Discussion

The 30-day readmission rate after surgery is 0.5%, with the majority of patients being readmitted for pain and wound-related issues, a small proportion of whom have deep infection requiring washout (0.06%). The 90-day DVT and PE rates are low. Of the patients, 4.5% required revision hip arthroscopy whereas 10.6% underwent hip replacement at a mean of 1.4 years after hip arthroscopy. Cox proportional hazard analysis adjusting for age, gender, and Charlson comorbidity score showed an 8-year

Conclusions

In this large series of 6,395 hip arthroscopies looking at the national data from the English NHS, our null hypothesis has been supported, and we have determined that the rate of short-term complications, in particular the risk of DVT and PE after this operation, is low. Higher age and female gender are significant predictors of conversion to THR, with Cox proportional hazard analyses showing a survivorship rate of 86% at 8 years after adjustment for confounding variables.

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    The authors report the following potential conflict of interest or source of funding: S.J. receives support from Stryker, Synthes, Smith & Nephew, DePuy, and Orthofix. P.J. receives support from CHKS Ltd. M.R.R. receives support from Heraeus, Ethicon, Convatec, Academic Health Science Network/Heraeus, The Health Foundation, Stryker, Biomet, BMI Healthcare, and CareFusion. P.F.P. receives support from Heraeus.

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