Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes Priscilla K. Cavanaugh, MS, Antonia F. Chen, MD, MBA, Mohammad R. Rasouli, MD, Zachary D. Post, MD, Fabio R. Orozco, MD, Alvin C. Ong, MD The Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania abstract article info Article history: Received 7 September 2014 Accepted 30 November 2014 Available online xxxx Keywords: organ transplant total hip arthroplasty total knee arthroplasty renal transplant complications This study aims to determine in-hospital complications and mortality in transplant recipients following total joint arthroplasty. The Nationwide Inpatient Sample database was queried for patients with history of transplant and joint arthroplasty (primary or revision) from 1993 to 2011. Kidney transplant increased risk of surgical site infection (SSI) and wound infections (OR = 2.03), systemic infection (OR = 2.85), deep venous thrombosis (OR = 2.07), acute renal failure (ARF) (OR = 3.48), respiratory (OR = 1.34), and cardiac (OR = 1.21) complications. Liver transplant was associated with SSI/wound infections (OR = 2.32), respiratory complications (OR = 1.68), cardiac complications (OR = 1.34), and ARF (OR = 4.48). Other transplants grouped together were associated with wound complications (OR = 2.13), respiratory complications (OR = 2.06), and ARF (OR = 4.42). Our study suggests these patients may be at increased risk of in-hospital complications, particularly ARF in renal and liver transplant patients. © 2014 Published by Elsevier Inc. Organ transplantation is an increasingly popular option for treating patients with end-stage organ failure. Annually, more than 12,000 kidney transplantations, 5000 liver transplantations and 2000 heart transplanta- tions are performed in the United States alone, and these numbers are expected to rise in the next several decades [1]. The overall long-term survival of transplant patients has improved despite long waiting times, coexisting comorbidities, obesity, increasing age, and higher degree of human leukocyte antigen (HLA) mismatch in patients undergoing organ transplantation [1,2]. This improvement is mainly due to precise patient selection, advancement in perioperative care, surgical technique and immunosuppressive medications [1]. With continued improvement in the survival rates of transplant recipients, more of these patients will subsequently require total joint arthroplasty (TJA) either due to degenerative joint disease or steroid- induced osteonecrosis [1]. However, chronic immunosuppression thera- py and poor bone quality make these patients susceptible to surgical site infection (SSI) and mechanical prosthesis failure, respectively [1,3,4]. Transplant patients are also at increased risk of bleeding due to thrombocytopenia [5]. Thus, performing TJA in transplant patients poses a challenging dilemma for orthopedic surgeons. More specifically, the paucity of literature regarding the outcome of TJA in patients with certain organ transplants, such as lung and pancreas, makes predicting outcomes difficult for surgeons. Therefore, the purpose of this study is to compare in-hospital com- plications in a large cohort of transplant recipients based on the type of transplant and type of TJA performed. Materials and Methods Nationwide Inpatient Sample (NIS) data from 1993 to 2011 was utilized for this study. Since the NIS database has been sufficiently de- identified, this study was exempt from institutional review board review. Patients with a history of transplant who underwent hip or knee arthroplasty (primary or revision) were identified using Interna- tional Classification of Diseases (ICD)-9 codes. The following codes were utilized for a history of transplant (V42.0: kidney, V42.1: heart, V42.6: lung, V42.7: liver, V42.81: bone marrow, V42.83: pancreas) and TJA codes (81.51: primary total hip arthroplasty [THA], 81.53, 00.70-00.73: revision THA, 81.54: primary total knee arthroplasty [TKA] and 81.55, 00.80-00.84: revision TKA). Patient comorbidities and perioperative complications were also identified using the same coding system. For all patients, patient demographics (age, sex, and race), insurance type, hospital type (urban academic, urban private, or rural), hospital size (small, medium, or large), region (Northeast, Midwest, West, and South), underlying joint disorder (osteoarthritis versus osteonecrosis) and in-hospital mortality were obtained. ICD-9 codes were used to identify postoperative cardiac, respiratory, pulmonary embolism (PE), deep venous thrombosis (DVT), SSI, systemic infection, acute renal failure (ARF) and wound related complications (Appendix 1). ICD-9 codes defined ARF as ARF with lesion of tubular necrosis, lesion of renal cortical The Journal of Arthroplasty xxx (2014) xxx–xxx The Conflict of Interest statement associated with this article can be found at http:// dx.doi.org/10.1016/j.arth.2014.11.037. Reprint requests: Alvin Ong, MD, 2500 English Creek Ave, Building 1300, Egg Harbor Township, NJ 08234. http://dx.doi.org/10.1016/j.arth.2014.11.037 0883-5403/© 2014 Published by Elsevier Inc. Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org Please cite this article as: Cavanaugh PK, et al, Total Joint Arthroplasty in Transplant Recipients: In-Hospital Adverse Outcomes, J Arthroplasty (2014), http://dx.doi.org/10.1016/j.arth.2014.11.037