The Impact of Chronic Obstructive Pulmonary Disease and Hospital Teaching Status on Mortality, Cost, and Length of Stay in Elective Total Hip Arthroplasty Patients

Introduction Total hip arthroplasty (THA) is a frequently performed surgery. Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the United States and has been associated with higher complications in many orthopedic surgeries. The purpose of this study was to examine the clinical and economic impacts of COPD on the mortality, cost, and length of stay of those undergoing THA and the effect of hospital teaching status on these outcomes. Methods This retrospective cohort study identified adult patients (≥18 years) utilizing information from the Healthcare Cost and Utilization Program Nationwide Inpatient Sample (NIS) from 2012 to 2014 undergoing elective THA using ICD-9 codes. Patients missing key clinical identifiers or those who did not undergo THA were excluded. Mortality, cost, and length of stay were assessed. The COPD cohort was further analyzed by hospital teaching status, including urban teaching, urban non-teaching, and rural. Results An adjusted total of 7,652 patients with COPD and 768,000 patients without COPD undergoing THA were identified. COPD was associated with higher mortality rates, longer lengths of stay, and total charges. In the COPD cohort, teaching status did affect outcomes. Between urban teaching hospitals and urban non-teaching, chronic conditions were significantly higher in urban teaching hospitals, yet total charges were lower. LOS was longer in rural hospitals, however, all other variables, including costs, were not significantly different as compared to urban teaching hospitals. Between urban non-teaching hospitals and rural hospitals, the number of chronic conditions and LOS were higher in rural hospitals, yet costs were significantly less. Age and mortality rates were not significantly different between different teaching statuses. Conclusion COPD has a significant effect on mortality, length of stay, and cost in patients undergoing THA. Additionally, teaching status seems to play an interesting role in these variables. Preoperative planning may help surgeons mitigate some of these risks associated with COPD. Further work on how LOS and costs are optimized with regards to teaching status should be done.