Rural Hospital Designation is Associated with Increased Complications and Resource Utilization After Primary Total Hip Arthroplasty: A Matched Case-Control Study.

INTRODUCTION As the prevalence of hip osteoarthritis increases, the demand for total hip arthroplasty (THA) has grown. It is known that patients in rural and urban geographic locations undergo THA at similar rates. This study explores the relationship between geographic location and postoperative outcomes. METHODS In this retrospective cohort study, the Truven Marketscan database was used to identify patients that underwent primary THA between January 2010 and December 2018. Patients with prior hip fracture, infection and/or avascular necrosis were excluded. Two cohorts were created based on geographic locations: urban versus rural (rural denotes any incorporated place with fewer than 2,500 inhabitants). Age, sex, and obesity were used for one-to-one matching between cohorts. Patient demographics, medical comorbidities, post-operative complications, and resource utilization were statistically compared between the cohorts using multivariate conditional logistic regression. RESULTS 18,712 patients were included for analysis (9,356 per cohort). After matching, there were no significant differences in comorbidities between cohorts. The following were more common in rural patients: dislocation within one year (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.08-1.41; P<0.001), revision within one year (OR, 1.17; 95% CI, 1.05-1.32; P=0.027), and prosthetic joint infection (OR, 1.14; 95% CI, 1.04-1.34; P=0.033). Similarly, rural patients had higher odds of 30-day readmission (OR, 1.31; 95% CI, 1.09-1.56; P=0.041), 90-day readmission (OR, 1.41; 95% CI, 1.26-1.71; P=0.023) and extended length of stay (≥3 days; OR, 1.52; 95% CI, 1.22-1.81; P<0.001). CONCLUSIONS Total hip arthroplasty in rural patients is associated with increased cost, healthcare utilization, and complications compared to urban patients. Standardization between geographic areas could reduce this discrepancy.