Gender Differences for Hip and Knee Arthroplasty: Complications and Healthcare Utilization Bryce A. Basques, MD, MHS a, * , Joshua A. Bell, MD a , Yale A. Fillingham, MD b , Jannat M. Khan, BS a , Craig J. Della Valle, MD a a Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL b Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH article info Article history: Received 4 December 2018 Received in revised form 25 March 2019 Accepted 26 March 2019 Available online xxx Keywords: gender total hip arthroplasty total knee arthroplasty complications healthcare utilization abstract Introduction: The influence of patient gender on complications and healthcare utilization remains un- explored. The purpose of the present study was to determine if patient gender significantly affected outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Retrospective cohort study of THA and TKA patients was performed using the Nationwide Inpatient Sample from 2002 to 2011. Only patients who underwent elective procedures and those with complete perioperative data were included. Multivariate logistic regression was used to compare the rates of adverse events between male and female cohorts while controlling for baseline characteristics. Results: A total of 6,123,637 patients were included in the study (31.2% THA and 68.8% TKA). The cohort was 61.1% female. While males had a lower rate of any adverse event (odds ratio [OR] ¼ 0.8, P < .001), urinary tract infection (OR ¼ 0.4, P < .001), deep vein thrombosis/pulmonary embolism (OR ¼ 0.9, P < .001), and blood transfusion (OR ¼ 0.5, P < .001), male gender was associated with statistically significant increases in the rates of death (OR ¼ 1.6, P < .001), acute kidney injury (OR ¼ 1.6, P < .001), cardiac arrest (OR ¼ 1.7, P < .001), myocardial infarction (OR ¼ 1.6, P < .001), pneumonia (OR ¼ 1.1, P < .001), sepsis (OR ¼ 1.6, P < .001), surgical site infection (OR ¼ 1.4, P < .001), and wound dehiscence (OR ¼ 1.4, P < .001). Conclusion: Males had increased rates of many individual adverse events. Females had higher rates of urinary tract infection, which translated to an overall higher rate of adverse events in females because of the rarity of the other individual adverse events. © 2019 Elsevier Inc. All rights reserved. Osteoarthritis has been implicated as the leading cause of musculoskeletal-related disability in the United States of America and Canada [1e3]. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are routinely performed to treat degenerative joint disease with approximately 300,000 THA and 700,000 TKA procedures performed annually in 2009 in the United States [4]. As the population of older individuals grows, the number of THA and TKA procedures performed annually is expected to increase 2-fold by 2020 [4]. Among the individuals treated with a THA or TKA, women had a higher prevalence than men across most age groups [5]. Despite the disparity in the utilization of total joint arthroplasty among men and women, the literature underreports gender dif- ferences in orthopedic outcomes. The focus on identifying gender differences in total joint arthroplasty has provided valuable information. Before patients undergo total joint arthroplasty, women are more fearful of hav- ing an arthroplasty procedure, willing to accept a greater amount of disability before considering surgery, and report worse pre- operative functional impairment [6e8]. Gender disparities have been found intraoperatively with males experiencing longer procedure times than women when undergoing THA and TKA surgeries [9]. We continue to observe gender disparities during the postoperative course. The prevalence of deep venous throm- bosis (DVT), pulmonary embolism (PE), and blood transfusion are One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2019.03.064. * Reprint requests: Bryce A. Basques, MD, MHS, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL. Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org https://doi.org/10.1016/j.arth.2019.03.064 0883-5403/© 2019 Elsevier Inc. All rights reserved. The Journal of Arthroplasty xxx (2019) 1e5