Predictors and risk factors of pulmonary embolism after total hip arthroplasty: an NSQIP study

Hip Int. 2025 Jan;35(1):70-75. doi: 10.1177/11207000241270205. Epub 2024 Aug 22.

Abstract

Introduction: Pulmonary embolism (PE) is a well-known contributor to morbidity after total hip arthroplasty (THA). Considerable efforts have been invested in reducing PE occurrence through pharmacological and perioperative interventions. Nonetheless, the effectiveness of these strategies in reducing the incidence and overall mortality associated with pulmonary embolism events remains a matter of debate. Therefore, identifying risky patients has been gaining importance.

Methods: We utilised data from the National Surgical Quality Improvement Program (NSQIP) participant usage file (PUF) database spanning the years 2016 to 2021. All preoperative parameters were analysed with chi-square afterwards, meaningful ones were run with logistic regression test.

Results: A study examined factors influencing pulmonary embolism (PE) prevalence in 235,393 total hip arthroplasty patients. Univariate analysis identified significant associations between PE and female gender, diabetes, smoking, dyspnea, CHF, COPD, hypertension (HT), bleeding disorders, disseminated cancer, steroid use, and functional health status. Multivariate analysis revealed male gender as protective, while COPD, hypertension, and disseminated cancer increased PE risk. Notably, smoking appeared protective. PE patients had higher return-to-operation rates (41.7% vs. 2.2%) but similar 30-day mortality (0.2% vs. 0.04%), though mortality's odds ratio was not significant.

Conclusions: Our findings suggest that certain patient characteristics, such as COPD and metastatic malignancy, significantly influence the likelihood of PE development.

Keywords: Complications; Hip Replacement; Pulmonary Embolism.

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip* / adverse effects
  • Databases, Factual
  • Female
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Postoperative Complications* / epidemiology
  • Pulmonary Embolism* / epidemiology
  • Pulmonary Embolism* / etiology
  • Quality Improvement
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Factors
  • United States / epidemiology