SAT0584 POORER OUTCOMES AND HIGHER HEALTHCARE UTILIZATION AFTER TOTAL HIP ARTHROPLASTY IN PATIENTS WITH LUPUS
Authors: Jasvinder Singh, John Cleveland
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Hip osteonecrosis and hip osteoarthritis are common causes of severe hip disease in lupus (1), both treated successfully with a total hip arthroplasty (THA). A recent systematic review of arthroplasty outcomes reported that the risk of overall complications post-THA was higher than in patients with lupus compared to those without lupus (2). However, no analyses were provided for specific outcomes such as infection, revision or associated health care utilization. <h3>Objectives:</h3> To assess the risk of specific post-THA outcomes, i.e., infection, transfusion, revision and mortality and associated health care utilization, associated with lupus. <h3>Methods:</h3> We used the 1998-2014 U.S. National Inpatient Sample data. Multivariable-adjusted separate Cox proportional hazard regression models assessed the association of lupus with post-operative complications (infection, transfusion, THA revision and mortality) and health care utilization outcomes (total hospital charges, discharge to inpatient facility, length of hospital stay) post-THA, adjusting for demographics, underlying diagnosis, comorbidity, insurance payer, and hospital characteristics, using hazard ratios (HR) and 95% confidence intervals (CI). <h3>Results:</h3> Among 4,116,485 primary THA hospitalizations, 22,557 (0.5%) were in lupus patients. Patients with lupus were younger, more likely to be female, African-American or Hispanic and, have higher comorbidity, Medicaid insurance payer, lower income, or living in the South. In multivariable-adjusted analyses, lupus was associated with a significantly higher risk of infection, transfusion, hospital charges above the median ($37,658) and discharge to inpatient facility, with respective HRs of 1.95 (95% CI, 1.28, 2.97), 1.34 (95% CI, 1.25, 1.43), 1.21 (95% CI, 1.01, 1.44) and 1.38 (95% CI, 1.30, 1.47). Lupus was not significantly associated with the risk of revision, mortality or hospital stay above the median (&gt;3 days), the HRs were 1.10 (95% CI, 0.68, 1.78) and 0.95 (95% CI, 0.61, 1.47) and 1.06 (95% CI, 0.99, 1.13). <h3>Conclusion:</h3> Lupus was associated with a higher risk of infection and transfusion and higher hospital charges post-primary THA. Insight into modifiable factors associated with these outcomes may improve outcomes in lupus patients undergoing THA. <h3>References</h3> [1] Mertelsmann-Voss C, Lyman S, Pan TJ, Goodman S, Figgie MP, Mandl LA. Arthroplasty rates are increased among US patients with systemic lupus erythematosus: 1991-2005. J Rheumatol2014;41:867-74. [2] Kennedy JW, Khan W. Total Hip Arthroplasty in Systemic Lupus Erythematosus: A Systematic Review. Int J Rheumatol2015;2015:475489. <h3>Acknowledgement:</h3> None <h3>Disclosure of Interests:</h3> jasvinder singh Shareholder of: Amarin pharmaceuticals and Viking therapeutics, Consultant for: Crealta/Horizon, Fidia, UBM LLC, Medscape, WebMD, the National Institutes of Health and the American College of Rheumatology, John Cleveland: None declared