Elective Total Hip Arthroplasty in Parkinson’s Disease: Increased 90-Day Readmission and Early Procedural Escalation

Elective Total Hip Arthroplasty in Parkinson’s Disease: Increased 90-Day Readmission and Early Procedural Escalation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Elective Total Hip Arthroplasty in Parkinson’s Disease: Increased 90-Day Readmission and Early Procedural Escalation David Maman, Yaniv Steinfeld, Yaron Berkovich This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8938793/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Background Patients with Parkinson’s disease (PD) undergoing total hip arthroplasty (THA) may be at increased risk for postoperative complications due to neuromuscular dysfunction and medical frailty. Contemporary national data on short-term outcomes following elective primary THA in this population remain limited. This study evaluated index hospitalization complications and 90-day readmission with procedural escalation after elective primary THA in patients with PD. Methods We performed a retrospective cohort study using the Nationwide Readmissions Database (2020–2022). Adult patients undergoing elective primary THA on hospital day 0 were identified. A 1:5 propensity score-matched cohort was constructed using demographics, payer, hospital characteristics, calendar year, and comorbidities (all standardized mean differences < 0.1). Index complications, 90-day readmission, and readmission-associated procedural escalation (any procedure, reoperation, and revision) were assessed. Results The matched cohort included 12,143 elective primary THAs (2,043 PD; 10,100 controls). PD was associated with higher rates of perioperative complications, including blood transfusion, pneumonia, urinary tract infection, and hip dislocation (all p ≤ 0.015), while in-hospital mortality remained low and similar between groups. Within 90 days, PD patients had higher readmission (10.3% vs 5.8%; OR 1.86; p < 0.001) and markedly increased procedural escalation, including reoperation (3.3% vs 0.9%) and revision (3.0% vs 0.7%) (all p < 0.001). Length of stay was longer in PD patients, with no significant difference in hospital charges. Conclusions Elective primary THA in patients with Parkinson’s disease is associated with increased perioperative complications and substantially higher 90-day readmission with early revision and reoperation. These findings highlight increased post-discharge vulnerability in this population and underscore the need for enhanced perioperative optimization and postoperative surveillance. Levels of Evidence: Level III Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Neurology Health sciences/Risk factors Total hip arthroplasty Parkinson’s disease Readmission Revision Reoperation Introduction Total hip arthroplasty (THA) reliably improves pain and function in patients with end-stage hip disease; however, certain comorbid conditions may increase perioperative risk and early postoperative vulnerability [ 1 ]. Parkinson’s disease (PD) is characterized by neuromuscular dysfunction, impaired balance, and medical frailty, all of which may adversely influence early recovery following THA [ 2 , 3 ]. These features create a biologically plausible risk for perioperative medical complications, instability-related events, and challenges with postoperative mobilization and discharge planning [ 4 ]. Prior literature suggests that patients with PD undergoing THA may experience higher complication rates and inferior functional outcomes, yet contemporary national data on short-term readmission and early surgical escalation remain limited [ 5 , 6 ]. In particular, the risk of rehospitalization and subsequent reoperation or revision within the early postoperative period has not been well defined at a population level [ 7 , 8 ]. Using a nationally representative readmissions database, we sought to evaluate perioperative complications, 90-day readmission, and readmission-associated procedural escalation after elective primary THA in patients with PD compared with a propensity score-matched cohort without PD. We hypothesized that PD would be associated with higher perioperative complication rates and increased early readmission with greater need for reoperation and revision, consistent with the broader literature linking frailty and neurologic comorbidity to adverse arthroplasty outcomes [ 9 ]. Methods Study Design and Data Source We performed a retrospective cohort study using the Nationwide Readmissions Database (NRD) for the years 2020 through 2022. The NRD is a nationally representative, all-payer administrative database developed within the Healthcare Cost and Utilization Project (HCUP). It contains discharge-level data from community hospitals across the United States and includes verified patient linkage identifiers that allow tracking of readmissions for the same individual within a given calendar year. Because the NRD contains de-identified publicly available data, institutional review board approval and informed consent were not required in accordance with federal policy on human subjects research. Cohort Identification Adult patients undergoing elective primary THA were identified using International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes recorded during the index hospitalization. To generate a clinically homogeneous cohort reflective of contemporary elective arthroplasty practice, several sequential inclusion and exclusion criteria were applied. First, analyses were restricted to elective admissions to eliminate confounding associated with trauma-related, fracture-related, infection-related, or malignancy-related arthroplasty indications. Second, to ensure uniform perioperative exposure and reduce bias from delayed surgery or in-hospital medical optimization, only cases in which THA was performed on hospital day 0 were included. Cases with procedures performed after hospital day 0 were excluded. To ensure complete ascertainment of 90-day outcomes within the NRD framework, index procedures performed between January 1 and September 30 of each study year were included, thereby allowing a full 90-day observation window within the same calendar year and preventing underestimation of readmission events occurring after year-end discharge. Exposure Definition: Parkinson’s Disease The exposure of interest was a diagnosis of PD, identified using ICD-10-CM diagnosis codes recorded during the index hospitalization. Patients with PD were compared with patients without PD undergoing elective primary THA. Outcomes Index Hospitalization Outcomes Index hospitalization outcomes included perioperative and in-hospital complications identified using validated diagnosis-based coding algorithms. These complications included blood loss anemia, blood transfusion, pneumonia, urinary tract infection, hip dislocation, intraoperative fracture, acute kidney injury, venous thromboembolism (deep vein thrombosis or pulmonary embolism), sepsis, respiratory failure, and in-hospital mortality. Resource utilization during the index admission included length of stay and total hospital charges. Ninety-Day Outcomes The primary outcome was all-cause 90-day readmission following elective primary THA. Readmissions were identified using NRD patient linkage variables and time-to-event metrics, allowing calculation of days from discharge to readmission. Secondary readmission-level outcomes focused on procedural escalation during readmission and included three prespecified categories: any inpatient procedure recorded during readmission, hip-related reoperation during readmission, and true component-level hip revision during readmission defined by ICD-10-PCS component revision code families. Additional readmission-level resource utilization outcomes included time to readmission, readmission length of stay, and readmission total hospital charges. Propensity Score Matching Given the non-random distribution of Parkinson’s disease and the potential for baseline clinical differences between cohorts, propensity score matching (PSM) was performed to improve comparability and reduce measured confounding. A propensity score representing the probability of having PD was estimated using multivariable logistic regression incorporating patient demographics (age, sex), calendar year, primary payer, hospital characteristics, and a comprehensive set of comorbidities relevant to arthroplasty outcomes, including hypertension, diabetes mellitus, chronic kidney disease, chronic lung disease, congestive heart failure, anemia, obesity, osteoporosis, peripheral vascular disease, cerebrovascular disease, and other major chronic conditions. Nearest-neighbor matching without replacement was conducted at a 1:5 ratio (PD:non-PD) to preserve the PD sample size while maximizing the number of comparable controls. Matching was constrained using a caliper width of 0.1 of the standard deviation of the logit of the propensity score to minimize poor-quality matches and ensure adequate overlap between groups. Post-match covariate balance was assessed using standardized mean differences (SMD), with an SMD < 0.1 considered indicative of acceptable balance. Adequate balance was achieved for all variables included in the propensity model. Matching was performed on unweighted discharge-level data to optimize internal validity and ensure high-quality covariate balance within the analytic cohort. After matching, NRD discharge-level sampling weights were re-applied to generate nationally representative estimates in accordance with HCUP methodology. Statistical Analysis Continuous variables are reported as mean ± standard deviation and were compared using independent-samples t-tests. Categorical variables are presented as percentages and were compared using chi-square tests or Fisher’s exact tests as appropriate based on expected cell counts. Effect sizes for binary outcomes are reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). All tests were two-sided, and statistical significance was defined as p < 0.05. All analyses were conducted within the propensity score-matched cohort. Statistical analyses were performed using SPSS using SPSS (IBM Corp., Armonk, NY). Results Study Cohort After 1:5 propensity score matching on age, sex, primary payer, hospital characteristics, calendar year, and all measured comorbidities, the final analytic cohort included 12,143 elective primary total hip arthroplasties (THA), comprising 2,043 patients with Parkinson’s disease (PD) and 10,100 matched controls without PD. All baseline covariates achieved adequate balance following matching, with standardized mean differences < 0.1 for all variables. Mean age was similar between groups (73.32 ± 8.16 vs 73.46 ± 8.19 years; p = 0.459), and sex distribution did not differ significantly (female: 44.4% vs 45.4%; p = 0.407). Calendar year of surgery was identical between groups (2020.77 ± 0.80 in both cohorts; p = 0.978), confirming successful temporal balance. Table 1 Baseline Characteristics After Propensity Score Matching Characteristic No PD (n = 10,100) PD (n = 2,043) p-value Age, years (mean ± SD) 73.46 ± 8.19 73.32 ± 8.16 0.459 Female, % 45.4 44.4 0.407 Calendar year (mean ± SD) 2020.77 ± 0.80 2020.77 ± 0.80 0.978 All covariates SMD < 0.1 < 0.1 - All analyses performed in 1:5 propensity-matched cohort with standardized mean differences < 0.1 for all matched variables. Perioperative and In-Hospital Complications During the index hospitalization, patients with Parkinson’s disease demonstrated higher rates of several postoperative complications. Blood loss anemia was significantly more frequent among PD patients (21.2% vs 15.5%; OR 1.46, 95% CI 1.30–1.65; p < 0.001), accompanied by increased utilization of blood transfusion (4.7% vs 2.9%; OR 1.66, 95% CI 1.31–2.11; p < 0.001). Pulmonary complications were notably higher in the PD cohort, with pneumonia occurring in 0.5% compared with 0.1% in matched controls (OR 6.21, 95% CI 2.45–15.74; p < 0.001). Urinary tract infection was also more common in PD patients (1.6% vs 1.0%; OR 1.64, 95% CI 1.10–2.45; p = 0.015). Hip-specific complications during the index admission were increased in PD patients, with a higher rate of dislocation (0.5% vs 0.1%; OR 3.54, 95% CI 1.57–7.99; p = 0.001). However, intraoperative fracture rates were similar between groups (0.9% vs 0.8%; p = 0.406). There were no significant differences in rates of acute kidney injury (3.0% vs 2.6%; p = 0.356), venous thromboembolism (deep vein thrombosis or pulmonary embolism), sepsis, or respiratory failure. Index in-hospital mortality was low and did not significantly differ between groups (0.2% vs 0.1%; p = 0.050). Table 2 Index Hospitalization Outcomes Outcome No PD PD OR (95% CI) p-value In-hospital mortality 0.1% 0.2% - 0.050 Blood loss anemia 15.5% 21.2% 1.46 (1.30–1.65) < 0.001 Blood transfusion 2.9% 4.7% 1.66 (1.31–2.11) < 0.001 Pneumonia 0.1% 0.5% 6.21 (2.45–15.74) < 0.001 Urinary tract infection 1.0% 1.6% 1.64 (1.10–2.45) 0.015 Hip dislocation 0.1% 0.5% 3.54 (1.57–7.99) 0.001 Intraoperative fracture 0.8% 0.9% - 0.406 AKI 2.6% 3.0% - 0.356 All analyses performed in 1:5 propensity-matched cohort with standardized mean differences < 0.1 for all matched variables. Ninety-Day Outcomes: Readmission and Procedural Escalation Within 90 days following discharge, Parkinson’s disease was associated with substantially higher rates of all-cause readmission. PD patients experienced a readmission rate of 10.3% compared with 5.8% among matched controls (OR 1.86, 95% CI 1.58–2.20; p < 0.001). Among readmitted patients, PD was strongly associated with higher rates of surgical escalation. True component-level revision during readmission occurred in 3.0% of PD patients versus 0.7% of controls (OR 4.36, 95% CI 3.09–6.14; p < 0.001). Similarly, hip-related reoperation during readmission was significantly more frequent in PD patients (3.3% vs 0.9%; OR 3.81, 95% CI 2.77–5.26; p < 0.001). Any procedure performed during readmission occurred in 6.8% of PD patients compared with 3.7% of controls (OR 1.92, 95% CI 1.57–2.35; p < 0.001). Time to readmission did not significantly differ between groups (31.37 ± 26.56 vs 28.84 ± 25.42 days; p = 0.223), suggesting that the excess risk in PD patients was related to higher overall vulnerability rather than earlier failure alone. Table 3 Ninety-Day Outcomes Outcome No PD PD OR (95% CI) p-value 90-day readmission 5.8% 10.3% 1.86 (1.58–2.20) < 0.001 Any procedure during readmission 3.7% 6.8% 1.92 (1.57–2.35) < 0.001 Hip-related reoperation 0.9% 3.3% 3.81 (2.77–5.26) < 0.001 True component-level revision 0.7% 3.0% 4.36 (3.09–6.14) < 0.001 All analyses performed in 1:5 propensity-matched cohort with standardized mean differences < 0.1 for all matched variables. Resource Utilization Patients with Parkinson’s disease had a longer index hospitalization length of stay (3.10 ± 3.81 vs 2.06 ± 2.51 days; p < 0.001). Index hospitalization charges were similar between groups ( $ 77,091 ± 52,895 vs $ 72,203 ± 48,395; p = 0.068). Among readmitted patients, readmission length of stay and readmission total charges did not significantly differ between cohorts (p = 0.677 and p = 0.951, respectively), indicating that the primary difference between groups was the higher likelihood of readmission and need for procedural intervention rather than increased per-episode resource utilization. Table 4 Resource Utilization Variable No PD PD p-value Length of stay, days 2.06 ± 2.51 3.10 ± 3.81 < 0.001 Index charges, USD 72,203 ± 48,395 77,091 ± 52,895 0.068 Time to readmission, days* 28.84 ± 25.42 31.37 ± 26.56 0.223 Readmission LOS, days* 5.24 ± 5.87 5.43 ± 5.49 0.677 Readmission charges, USD* 78,166 ± 110,570 78,668 ± 71,728 0.951 All analyses performed in 1:5 propensity-matched cohort with standardized mean differences < 0.1 for all matched variables. Discussion In this contemporary propensity score-matched national analysis of elective primary THA performed on hospital day 0, Parkinson’s disease was associated with a clear increase in early postoperative vulnerability. Patients with PD experienced nearly double the odds of 90-day readmission compared with matched controls (10.3% vs 5.8%), and, importantly, readmission in PD was more frequently accompanied by procedural escalation, including hip-related reoperation and true component-level revision. These findings suggest that the early postoperative course in PD is not only characterized by more frequent rehospitalization, but also by a higher likelihood of clinically meaningful failure requiring operative intervention. This pattern aligns with prior observations that neurologic disease and frailty are independently associated with increased complications and poorer short-term arthroplasty outcomes [ 10 , 11 ]. The increased readmission signal was accompanied by higher rates of select index-admission complications. PD patients demonstrated higher odds of blood loss anemia and transfusion, which may reflect baseline frailty, medication-related factors, lower physiologic reserve, or perioperative mobilization limitations that influence hemodilution, nutrition, and tolerance of anemia. PD was also associated with higher rates of pneumonia and urinary tract infection, consistent with the known susceptibility of neurologically impaired patients to pulmonary and urinary complications during early recovery [ 12 , 13 ]. While absolute event rates for some complications were low, the relative increases were consistent and clinically relevant, particularly given the downstream association between early medical complications and readmission [ 14 ]. Hip-specific instability appeared to contribute as well. PD patients had higher rates of dislocation during the index hospitalization and substantially higher rates of readmission-associated reoperation and revision. Although the NRD does not provide laterality, implant details, surgical approach, or radiographic parameters, the pattern aligns with a plausible mechanism in which impaired neuromuscular control, rigidity, dyskinesia, and fall risk increase instability-related events and may predispose to early mechanical complications requiring surgical management [ 15 , 16 ]. Prior studies have demonstrated elevated dislocation and revision risks among patients with neuromuscular disorders and Parkinsonian syndromes undergoing hip arthroplasty, supporting this mechanistic interpretation [ 17 ]. Notably, intraoperative fracture and acute kidney injury did not differ significantly between cohorts, suggesting that the observed differences were not driven by broad increases across all perioperative adverse events but rather by specific medical and hip-related complications. This selective complication profile mirrors broader literature indicating that neurologic comorbidity tends to influence postoperative recovery dynamics and functional resilience more than intraoperative technical complication rates [ 18 ]. Resource utilization patterns provide additional context. PD was associated with a longer index length of stay, which is consistent with more complex discharge planning, slower rehabilitation, and higher rates of early complications. However, index hospitalization charges were not significantly different, and among those readmitted, readmission charges and length of stay were similar between groups. Taken together, these findings imply that the principal driver of increased resource burden in PD is the higher incidence of readmission and operative escalation, rather than greater intensity of resource utilization per readmission episode. Similar patterns have been described in frail and neurologically impaired arthroplasty populations, where excess costs are primarily mediated through higher complication and readmission rates rather than increased per-admission expenditures [ 19 ]. This study has several important implications for perioperative counseling and care pathways. First, PD should be considered a meaningful risk marker for early readmission and early surgical escalation after elective THA-even after rigorous matching on demographics, payer, hospital characteristics, and comorbidity burden. Second, the complication profile highlights targets for mitigation: optimizing perioperative pulmonary hygiene, early mobilization strategies tailored to PD, dysphagia screening where appropriate, careful urinary management, and heightened vigilance for instability. Third, the increased early revision and reoperation signal supports deliberate intraoperative strategies to reduce instability risk, as well as close early follow-up and structured rehabilitation planning. These recommendations are consistent with emerging perioperative optimization frameworks for high-risk and frail arthroplasty patients [ 20 , 21 ]. Limitations These results should be interpreted considering limitations inherent to administrative claims data. Outcomes and comorbidities were identified using ICD-10 coding and are subject to misclassification [ 14 ]. The NRD captures readmissions only within a calendar year; we therefore restricted index procedures to January–September to preserve complete 90-day capture, but residual censoring and out-of-hospital events are not measured. The database does not include PD severity, functional status, medication regimen, surgical approach, implant selection (including head size and constraint), surgeon volume, laterality, or granular rehabilitation variables, limiting mechanistic inference and preventing evaluation of specific surgical strategies [ 15 , 18 ]. Additionally, although propensity score matching achieved excellent balance across measured covariates (SMD < 0.1), unmeasured confounding remains possible. Finally, some individual outcomes were rare, and small cell counts may widen uncertainty despite statistically significant relative differences. Conclusions In a nationally representative, propensity score-matched cohort of elective primary THA performed on hospital day 0, Parkinson’s disease was associated with higher rates of select in-hospital complications, longer index length of stay, and markedly increased 90-day readmission. Readmissions in PD were more frequently accompanied by procedural escalation, including hip-related reoperation and true component-level revision. These findings support enhanced perioperative risk counseling and targeted optimization strategies for patients with PD undergoing elective THA, with particular attention to early medical complications and instability-related risk. Declarations Levels of Evidence Level III Consent for Publication Not applicable. No individual person’s identifiable data are included. Consent to Participate Not applicable. No human participants were directly recruited. Competing Interests The authors declare no conflicts of interest. Funding Declaration No external funding was received for this study. Author Contribution DM: Conceptualization, data extraction, statistical analysis, manuscript drafting.YS: Study design, interpretation of results, critical revision.YB: Conceptualization, supervision, manuscript review and editing.All authors approved the final version. Data Availability This study used publicly available data from the HCUP Nationwide Readmissions Database (NRD). Data can be obtained directly from HCUP ( [https://hcup-us.ahrq.gov/dataoverview.jsp](https:/hcup-us.ahrq.gov/dataoverview.jsp) ) upon purchase. References Sloan, M., Premkumar, A., Sheth, N. P. & the U.S.. Projected Volume of Primary Total Joint Arthroplasty in, 2014 to 2030. J Bone Joint Surg Am. ;100(17):1455–1460. doi: 10.2106/JBJS.17.01617. PMID: 30180053. (2018). Fasano, A., Canning, C. G., Hausdorff, J. M., Lord, S. & Rochester, L. Falls in Parkinson's disease: A complex and evolving picture. Mov. Disord . 32 (11), 1524–1536. 10.1002/mds.27195 (2017). Epub 2017 Oct 25. PMID: 29067726. Mak, M. K. Y. & Wong-Yu, I. S. K. Exercise for Parkinson's disease. Int. Rev. Neurobiol. 147 , 1–44. 10.1016/bs.irn.2019.06.001 (2019). Epub 2019 Jun 27. PMID: 31607351. Newman, J. M. et al. Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study. J Arthroplasty. ;33(7S):S162-S166. (2018). 10.1016/j.arth.2018.01.006 . Epub 2018 Jan 16. PMID: 29402715. O'Driscoll, C. S., Hughes, A. J., Davey, M. S., Queally, J. M. & O'Daly, B. J. Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review. Arthroplast Today . 19 , 101068 (2022). PMID: 36568851; PMCID: PMC9768244. Courtney, P. M., Boniello, A. J. & Berger, R. A. Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. J. Arthroplasty . 32 (5), 1426–1430. 10.1016/j.arth.2016.11.055 (2017). Epub 2016 Dec 14. PMID: 28034481. Bovonratwet, P. et al. What Are the Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Hip Arthroplasty? J Arthroplasty. ;36(7S):S258-S263.e1. (2021). 10.1016/j.arth.2020.10.011 . Epub 2020 Oct 15. PMID: 33162278. Mian, H., Lyons, J., Perrin, J., Froehle, A., Krishnamurthy, A. & & & & A review of current practices in periprosthetic joint infection debridement and revision arthroplasty. Arthroplasty 4 10.1186/s42836-022-00136-5 (2022). Traven, S. A., Reeves, R. A., Slone, H. S. & Walton, Z. J. Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty. J. Arthroplasty . 34 (7), 1412–1416. 10.1016/j.arth.2019.02.060 (2019). Epub 2019 Mar 7. PMID: 30930155. Loth, F. L. et al. Impact of Comorbidities on Outcome After Total Hip Arthroplasty. J. Arthroplasty . 32 (9), 2755–2761. 10.1016/j.arth.2017.04.013 (2017). Epub 2017 Apr 19. PMID: 28506675. Shin, J. I., Keswani, A., Lovy, A. J. & Moucha, C. S. Simplified Frailty Index as a Predictor of Adverse Outcomes in Total Hip and Knee Arthroplasty. J. Arthroplasty . 31 (11), 2389–2394. 10.1016/j.arth.2016.04.020 (2016). Epub 2016 Apr 27. PMID: 27240960. Pepper, P. V. & Goldstein, M. K. Postoperative complications in Parkinson's disease. J Am Geriatr Soc. ;47(8):967 – 72. (1999). 10.1111/j.1532-5415.1999.tb01292.x . PMID: 10443858. Torsney, K. M. & Forsyth, D. Respiratory dysfunction in Parkinson's disease. J R Coll Physicians Edinb. ;47(1):35–39. (2017). 10.4997/JRCPE.2017.108 . PMID: 28569280. Pugely, A. J., Martin, C. T., Gao, Y., Schweizer, M. L. & Callaghan, J. J. The Incidence of and Risk Factors for 30-Day Surgical Site Infections Following Primary and Revision Total Joint Arthroplasty. J Arthroplasty. ;30(9 Suppl):47–50. doi: 10.1016/j.arth.2015.01.063. Epub 2015 Jun 3. PMID: 26071247. (2015). Konan, S. & Duncan, C. P. Total hip arthroplasty in patients with neuromuscular imbalance. Bone Joint J. ;100-B(1 Supple A):17–21. (2018). 10.1302/0301-620X.100B1.BJJ-2017-0571.R1 . PMID: 29292335; PMCID: PMC6424437. Walker, R. W., Chaplin, A., Hancock, R. L., Rutherford, R. & Gray, W. K. Hip fractures in people with idiopathic Parkinson's disease: incidence and outcomes. Mov. Disord . 28 (3), 334–340. 10.1002/mds.25297 (2013). Epub 2013 Feb 6. PMID: 23389925. Lazennec, J. Y., Kim, Y. & Pour, A. E. Total Hip Arthroplasty in Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants and Cementless Fixation. J. Arthroplasty . 33 (5), 1455–1461 (2018). Epub 2017 Dec 5. PMID: 29276118. Hall, G. M., Peerbhoy, D., Shenkin, A., Parker, C. J. & Salmon, P. Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses. Br J Anaesth. ;87(4):537 – 42. (2001). 10.1093/bja/87.4.537 . PMID: 11878721. Tram, M. K. et al. Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Total Hip Arthroplasty. J. Arthroplasty . 39 (5), 1151–1156e4 (2024). Epub 2023 Dec 21. PMID: 38135165. Wainwright, T. W. et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations. Acta Orthop. ;91(1):3–19. doi: 10.1080/17453674.2019.1683790. Epub 2019 Oct 30. Update in: Acta Orthop. 2020;91(3):363. doi: 10.1080/17453674.2020.1724674. PMID: 31663402; PMCID: PMC7006728. (2020). Jin, Z., Rismany, J., Gidicsin, C. & Bergese, S. D. Frailty: the perioperative and anesthesia challenges of an emerging pandemic. J. Anesth. 37 (4), 624–640. 10.1007/s00540-023-03206-3 (2023). Epub 2023 Jun 13. PMID: 37311899; PMCID: PMC10263381. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 11 May, 2026 Reviewers invited by journal 18 Mar, 2026 Editor invited by journal 02 Mar, 2026 Editor assigned by journal 25 Feb, 2026 Submission checks completed at journal 25 Feb, 2026 First submitted to journal 22 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8938793","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":609757687,"identity":"73cb8fe0-faaa-41c9-84e4-560f4925e73e","order_by":0,"name":"David Maman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYPACZhAyfABkJYDYYMDGTliLscEBFC3M+HRAlJlJgLWgCmIC3fbTiZ8LGKzlDY4zb6v+UGGXZ87OfOwBQ40dAx8OLWZncjdLz2BIN9xwmK3sxoEzycWWzWzpBgzHknE6zOxA7gZpHobDjDObecxuHGw7kLjhMI+ZBAPbAdxazr/d/BuoxR6kpeDgP5iWf3i03MjdBrIlsZ+Zx4zhYANUC2MbPi1vt1nzGKQn9zOzFUucOZYM1MKWJpHYl8yD22G5m2/zVFjbtvEf3vihosYuccP5w8ckPnyzk5Nvb8CuBwwM0AUSGBh48KgfBaNgFIyCUUAAAADewVWsgFz7+QAAAABJRU5ErkJggg==","orcid":"","institution":"Technion – Israel Institute of Technology","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Maman","suffix":""},{"id":609757689,"identity":"59218bc8-792c-47aa-a6f8-20871a638d56","order_by":1,"name":"Yaniv Steinfeld","email":"","orcid":"","institution":"Carmel Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yaniv","middleName":"","lastName":"Steinfeld","suffix":""},{"id":609757706,"identity":"aa030a19-aaa9-4e00-be2b-8f560cc7e612","order_by":2,"name":"Yaron Berkovich","email":"","orcid":"","institution":"Carmel Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Yaron","middleName":"","lastName":"Berkovich","suffix":""}],"badges":[],"createdAt":"2026-02-22 11:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8938793/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8938793/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105563614,"identity":"6cf6dc7c-ac12-497a-b227-95ee264f4776","added_by":"auto","created_at":"2026-03-27 12:47:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":694508,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8938793/v1/b1df9017-6c3f-49b9-b2ac-dd2287b94cdb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Elective Total Hip Arthroplasty in Parkinson’s Disease: Increased 90-Day Readmission and Early Procedural Escalation","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTotal hip arthroplasty (THA) reliably improves pain and function in patients with end-stage hip disease; however, certain comorbid conditions may increase perioperative risk and early postoperative vulnerability [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Parkinson\u0026rsquo;s disease (PD) is characterized by neuromuscular dysfunction, impaired balance, and medical frailty, all of which may adversely influence early recovery following THA [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These features create a biologically plausible risk for perioperative medical complications, instability-related events, and challenges with postoperative mobilization and discharge planning [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrior literature suggests that patients with PD undergoing THA may experience higher complication rates and inferior functional outcomes, yet contemporary national data on short-term readmission and early surgical escalation remain limited [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In particular, the risk of rehospitalization and subsequent reoperation or revision within the early postoperative period has not been well defined at a population level [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUsing a nationally representative readmissions database, we sought to evaluate perioperative complications, 90-day readmission, and readmission-associated procedural escalation after elective primary THA in patients with PD compared with a propensity score-matched cohort without PD. We hypothesized that PD would be associated with higher perioperative complication rates and increased early readmission with greater need for reoperation and revision, consistent with the broader literature linking frailty and neurologic comorbidity to adverse arthroplasty outcomes [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Data Source\u003c/h2\u003e \u003cp\u003eWe performed a retrospective cohort study using the Nationwide Readmissions Database (NRD) for the years 2020 through 2022. The NRD is a nationally representative, all-payer administrative database developed within the Healthcare Cost and Utilization Project (HCUP). It contains discharge-level data from community hospitals across the United States and includes verified patient linkage identifiers that allow tracking of readmissions for the same individual within a given calendar year.\u003c/p\u003e \u003cp\u003eBecause the NRD contains de-identified publicly available data, institutional review board approval and informed consent were not required in accordance with federal policy on human subjects research.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCohort Identification\u003c/h3\u003e\n\u003cp\u003eAdult patients undergoing elective primary THA were identified using International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) codes recorded during the index hospitalization. To generate a clinically homogeneous cohort reflective of contemporary elective arthroplasty practice, several sequential inclusion and exclusion criteria were applied.\u003c/p\u003e \u003cp\u003eFirst, analyses were restricted to elective admissions to eliminate confounding associated with trauma-related, fracture-related, infection-related, or malignancy-related arthroplasty indications. Second, to ensure uniform perioperative exposure and reduce bias from delayed surgery or in-hospital medical optimization, only cases in which THA was performed on hospital day 0 were included. Cases with procedures performed after hospital day 0 were excluded.\u003c/p\u003e \u003cp\u003eTo ensure complete ascertainment of 90-day outcomes within the NRD framework, index procedures performed between January 1 and September 30 of each study year were included, thereby allowing a full 90-day observation window within the same calendar year and preventing underestimation of readmission events occurring after year-end discharge.\u003c/p\u003e\n\u003ch3\u003eExposure Definition: Parkinson’s Disease\u003c/h3\u003e\n\u003cp\u003eThe exposure of interest was a diagnosis of PD, identified using ICD-10-CM diagnosis codes recorded during the index hospitalization. Patients with PD were compared with patients without PD undergoing elective primary THA.\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eIndex Hospitalization Outcomes\u003c/h2\u003e \u003cp\u003eIndex hospitalization outcomes included perioperative and in-hospital complications identified using validated diagnosis-based coding algorithms. These complications included blood loss anemia, blood transfusion, pneumonia, urinary tract infection, hip dislocation, intraoperative fracture, acute kidney injury, venous thromboembolism (deep vein thrombosis or pulmonary embolism), sepsis, respiratory failure, and in-hospital mortality.\u003c/p\u003e \u003cp\u003eResource utilization during the index admission included length of stay and total hospital charges.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eNinety-Day Outcomes\u003c/h2\u003e \u003cp\u003eThe primary outcome was all-cause 90-day readmission following elective primary THA. Readmissions were identified using NRD patient linkage variables and time-to-event metrics, allowing calculation of days from discharge to readmission.\u003c/p\u003e \u003cp\u003eSecondary readmission-level outcomes focused on procedural escalation during readmission and included three prespecified categories:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eany inpatient procedure recorded during readmission,\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ehip-related reoperation during readmission, and\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003etrue component-level hip revision during readmission defined by ICD-10-PCS component revision code families.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eAdditional readmission-level resource utilization outcomes included time to readmission, readmission length of stay, and readmission total hospital charges.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePropensity Score Matching\u003c/h3\u003e\n\u003cp\u003eGiven the non-random distribution of Parkinson\u0026rsquo;s disease and the potential for baseline clinical differences between cohorts, propensity score matching (PSM) was performed to improve comparability and reduce measured confounding. A propensity score representing the probability of having PD was estimated using multivariable logistic regression incorporating patient demographics (age, sex), calendar year, primary payer, hospital characteristics, and a comprehensive set of comorbidities relevant to arthroplasty outcomes, including hypertension, diabetes mellitus, chronic kidney disease, chronic lung disease, congestive heart failure, anemia, obesity, osteoporosis, peripheral vascular disease, cerebrovascular disease, and other major chronic conditions.\u003c/p\u003e \u003cp\u003eNearest-neighbor matching without replacement was conducted at a 1:5 ratio (PD:non-PD) to preserve the PD sample size while maximizing the number of comparable controls. Matching was constrained using a caliper width of 0.1 of the standard deviation of the logit of the propensity score to minimize poor-quality matches and ensure adequate overlap between groups.\u003c/p\u003e \u003cp\u003ePost-match covariate balance was assessed using standardized mean differences (SMD), with an SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.1 considered indicative of acceptable balance. Adequate balance was achieved for all variables included in the propensity model.\u003c/p\u003e \u003cp\u003eMatching was performed on unweighted discharge-level data to optimize internal validity and ensure high-quality covariate balance within the analytic cohort. After matching, NRD discharge-level sampling weights were re-applied to generate nationally representative estimates in accordance with HCUP methodology.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are reported as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and were compared using independent-samples t-tests. Categorical variables are presented as percentages and were compared using chi-square tests or Fisher\u0026rsquo;s exact tests as appropriate based on expected cell counts.\u003c/p\u003e \u003cp\u003eEffect sizes for binary outcomes are reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs). All tests were two-sided, and statistical significance was defined as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003eAll analyses were conducted within the propensity score-matched cohort. Statistical analyses were performed using SPSS using SPSS (IBM Corp., Armonk, NY).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy Cohort\u003c/h2\u003e \u003cp\u003eAfter 1:5 propensity score matching on age, sex, primary payer, hospital characteristics, calendar year, and all measured comorbidities, the final analytic cohort included 12,143 elective primary total hip arthroplasties (THA), comprising 2,043 patients with Parkinson\u0026rsquo;s disease (PD) and 10,100 matched controls without PD. All baseline covariates achieved adequate balance following matching, with standardized mean differences\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for all variables.\u003c/p\u003e \u003cp\u003eMean age was similar between groups (73.32\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16 vs 73.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19 years; p\u0026thinsp;=\u0026thinsp;0.459), and sex distribution did not differ significantly (female: 44.4% vs 45.4%; p\u0026thinsp;=\u0026thinsp;0.407). Calendar year of surgery was identical between groups (2020.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80 in both cohorts; p\u0026thinsp;=\u0026thinsp;0.978), confirming successful temporal balance.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics After Propensity Score Matching\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo PD (n\u0026thinsp;=\u0026thinsp;10,100)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePD (n\u0026thinsp;=\u0026thinsp;2,043)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.46\u0026thinsp;\u0026plusmn;\u0026thinsp;8.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.32\u0026thinsp;\u0026plusmn;\u0026thinsp;8.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalendar year (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2020.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2020.77\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.978\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll covariates SMD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAll analyses performed in 1:5 propensity-matched cohort with standardized mean differences\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for all matched variables.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePerioperative and In-Hospital Complications\u003c/h2\u003e \u003cp\u003eDuring the index hospitalization, patients with Parkinson\u0026rsquo;s disease demonstrated higher rates of several postoperative complications. Blood loss anemia was significantly more frequent among PD patients (21.2% vs 15.5%; OR 1.46, 95% CI 1.30\u0026ndash;1.65; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), accompanied by increased utilization of blood transfusion (4.7% vs 2.9%; OR 1.66, 95% CI 1.31\u0026ndash;2.11; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003ePulmonary complications were notably higher in the PD cohort, with pneumonia occurring in 0.5% compared with 0.1% in matched controls (OR 6.21, 95% CI 2.45\u0026ndash;15.74; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Urinary tract infection was also more common in PD patients (1.6% vs 1.0%; OR 1.64, 95% CI 1.10\u0026ndash;2.45; p\u0026thinsp;=\u0026thinsp;0.015).\u003c/p\u003e \u003cp\u003eHip-specific complications during the index admission were increased in PD patients, with a higher rate of dislocation (0.5% vs 0.1%; OR 3.54, 95% CI 1.57\u0026ndash;7.99; p\u0026thinsp;=\u0026thinsp;0.001). However, intraoperative fracture rates were similar between groups (0.9% vs 0.8%; p\u0026thinsp;=\u0026thinsp;0.406).\u003c/p\u003e \u003cp\u003eThere were no significant differences in rates of acute kidney injury (3.0% vs 2.6%; p\u0026thinsp;=\u0026thinsp;0.356), venous thromboembolism (deep vein thrombosis or pulmonary embolism), sepsis, or respiratory failure.\u003c/p\u003e \u003cp\u003eIndex in-hospital mortality was low and did not significantly differ between groups (0.2% vs 0.1%; p\u0026thinsp;=\u0026thinsp;0.050).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIndex Hospitalization Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo PD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-hospital mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood loss anemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.46 (1.30\u0026ndash;1.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.66 (1.31\u0026ndash;2.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePneumonia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.21 (2.45\u0026ndash;15.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrinary tract infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.64 (1.10\u0026ndash;2.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip dislocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.54 (1.57\u0026ndash;7.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraoperative fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.406\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAll analyses performed in 1:5 propensity-matched cohort with standardized mean differences\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for all matched variables.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eNinety-Day Outcomes: Readmission and Procedural Escalation\u003c/h2\u003e \u003cp\u003eWithin 90 days following discharge, Parkinson\u0026rsquo;s disease was associated with substantially higher rates of all-cause readmission. PD patients experienced a readmission rate of 10.3% compared with 5.8% among matched controls (OR 1.86, 95% CI 1.58\u0026ndash;2.20; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eAmong readmitted patients, PD was strongly associated with higher rates of surgical escalation. True component-level revision during readmission occurred in 3.0% of PD patients versus 0.7% of controls (OR 4.36, 95% CI 3.09\u0026ndash;6.14; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Similarly, hip-related reoperation during readmission was significantly more frequent in PD patients (3.3% vs 0.9%; OR 3.81, 95% CI 2.77\u0026ndash;5.26; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Any procedure performed during readmission occurred in 6.8% of PD patients compared with 3.7% of controls (OR 1.92, 95% CI 1.57\u0026ndash;2.35; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eTime to readmission did not significantly differ between groups (31.37\u0026thinsp;\u0026plusmn;\u0026thinsp;26.56 vs 28.84\u0026thinsp;\u0026plusmn;\u0026thinsp;25.42 days; p\u0026thinsp;=\u0026thinsp;0.223), suggesting that the excess risk in PD patients was related to higher overall vulnerability rather than earlier failure alone.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNinety-Day Outcomes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo PD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e90-day readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.86 (1.58\u0026ndash;2.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny procedure during readmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.92 (1.57\u0026ndash;2.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip-related reoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.81 (2.77\u0026ndash;5.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrue component-level revision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.36 (3.09\u0026ndash;6.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAll analyses performed in 1:5 propensity-matched cohort with standardized mean differences\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for all matched variables.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eResource Utilization\u003c/h2\u003e \u003cp\u003ePatients with Parkinson\u0026rsquo;s disease had a longer index hospitalization length of stay (3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81 vs 2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51 days; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Index hospitalization charges were similar between groups (\u003cspan\u003e$\u003c/span\u003e77,091\u0026thinsp;\u0026plusmn;\u0026thinsp;52,895 vs \u003cspan\u003e$\u003c/span\u003e72,203\u0026thinsp;\u0026plusmn;\u0026thinsp;48,395; p\u0026thinsp;=\u0026thinsp;0.068).\u003c/p\u003e \u003cp\u003eAmong readmitted patients, readmission length of stay and readmission total charges did not significantly differ between cohorts (p\u0026thinsp;=\u0026thinsp;0.677 and p\u0026thinsp;=\u0026thinsp;0.951, respectively), indicating that the primary difference between groups was the higher likelihood of readmission and need for procedural intervention rather than increased per-episode resource utilization.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResource Utilization\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo PD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay, days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e2.06\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e3.10\u0026thinsp;\u0026plusmn;\u0026thinsp;3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndex charges, USD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e72,203\u0026thinsp;\u0026plusmn;\u0026thinsp;48,395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e77,091\u0026thinsp;\u0026plusmn;\u0026thinsp;52,895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime to readmission, days*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e28.84\u0026thinsp;\u0026plusmn;\u0026thinsp;25.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e31.37\u0026thinsp;\u0026plusmn;\u0026thinsp;26.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission LOS, days*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e5.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.43\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.677\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReadmission charges, USD*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e78,166\u0026thinsp;\u0026plusmn;\u0026thinsp;110,570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e78,668\u0026thinsp;\u0026plusmn;\u0026thinsp;71,728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eAll analyses performed in 1:5 propensity-matched cohort with standardized mean differences\u0026thinsp;\u0026lt;\u0026thinsp;0.1 for all matched variables.\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this contemporary propensity score-matched national analysis of elective primary THA performed on hospital day 0, Parkinson\u0026rsquo;s disease was associated with a clear increase in early postoperative vulnerability. Patients with PD experienced nearly double the odds of 90-day readmission compared with matched controls (10.3% vs 5.8%), and, importantly, readmission in PD was more frequently accompanied by procedural escalation, including hip-related reoperation and true component-level revision. These findings suggest that the early postoperative course in PD is not only characterized by more frequent rehospitalization, but also by a higher likelihood of clinically meaningful failure requiring operative intervention. This pattern aligns with prior observations that neurologic disease and frailty are independently associated with increased complications and poorer short-term arthroplasty outcomes [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe increased readmission signal was accompanied by higher rates of select index-admission complications. PD patients demonstrated higher odds of blood loss anemia and transfusion, which may reflect baseline frailty, medication-related factors, lower physiologic reserve, or perioperative mobilization limitations that influence hemodilution, nutrition, and tolerance of anemia. PD was also associated with higher rates of pneumonia and urinary tract infection, consistent with the known susceptibility of neurologically impaired patients to pulmonary and urinary complications during early recovery [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. While absolute event rates for some complications were low, the relative increases were consistent and clinically relevant, particularly given the downstream association between early medical complications and readmission [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHip-specific instability appeared to contribute as well. PD patients had higher rates of dislocation during the index hospitalization and substantially higher rates of readmission-associated reoperation and revision. Although the NRD does not provide laterality, implant details, surgical approach, or radiographic parameters, the pattern aligns with a plausible mechanism in which impaired neuromuscular control, rigidity, dyskinesia, and fall risk increase instability-related events and may predispose to early mechanical complications requiring surgical management [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Prior studies have demonstrated elevated dislocation and revision risks among patients with neuromuscular disorders and Parkinsonian syndromes undergoing hip arthroplasty, supporting this mechanistic interpretation [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Notably, intraoperative fracture and acute kidney injury did not differ significantly between cohorts, suggesting that the observed differences were not driven by broad increases across all perioperative adverse events but rather by specific medical and hip-related complications. This selective complication profile mirrors broader literature indicating that neurologic comorbidity tends to influence postoperative recovery dynamics and functional resilience more than intraoperative technical complication rates [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResource utilization patterns provide additional context. PD was associated with a longer index length of stay, which is consistent with more complex discharge planning, slower rehabilitation, and higher rates of early complications. However, index hospitalization charges were not significantly different, and among those readmitted, readmission charges and length of stay were similar between groups. Taken together, these findings imply that the principal driver of increased resource burden in PD is the higher incidence of readmission and operative escalation, rather than greater intensity of resource utilization per readmission episode. Similar patterns have been described in frail and neurologically impaired arthroplasty populations, where excess costs are primarily mediated through higher complication and readmission rates rather than increased per-admission expenditures [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several important implications for perioperative counseling and care pathways. First, PD should be considered a meaningful risk marker for early readmission and early surgical escalation after elective THA-even after rigorous matching on demographics, payer, hospital characteristics, and comorbidity burden. Second, the complication profile highlights targets for mitigation: optimizing perioperative pulmonary hygiene, early mobilization strategies tailored to PD, dysphagia screening where appropriate, careful urinary management, and heightened vigilance for instability. Third, the increased early revision and reoperation signal supports deliberate intraoperative strategies to reduce instability risk, as well as close early follow-up and structured rehabilitation planning. These recommendations are consistent with emerging perioperative optimization frameworks for high-risk and frail arthroplasty patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThese results should be interpreted considering limitations inherent to administrative claims data. Outcomes and comorbidities were identified using ICD-10 coding and are subject to misclassification [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The NRD captures readmissions only within a calendar year; we therefore restricted index procedures to January\u0026ndash;September to preserve complete 90-day capture, but residual censoring and out-of-hospital events are not measured. The database does not include PD severity, functional status, medication regimen, surgical approach, implant selection (including head size and constraint), surgeon volume, laterality, or granular rehabilitation variables, limiting mechanistic inference and preventing evaluation of specific surgical strategies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Additionally, although propensity score matching achieved excellent balance across measured covariates (SMD\u0026thinsp;\u0026lt;\u0026thinsp;0.1), unmeasured confounding remains possible. Finally, some individual outcomes were rare, and small cell counts may widen uncertainty despite statistically significant relative differences.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn a nationally representative, propensity score-matched cohort of elective primary THA performed on hospital day 0, Parkinson\u0026rsquo;s disease was associated with higher rates of select in-hospital complications, longer index length of stay, and markedly increased 90-day readmission. Readmissions in PD were more frequently accompanied by procedural escalation, including hip-related reoperation and true component-level revision. These findings support enhanced perioperative risk counseling and targeted optimization strategies for patients with PD undergoing elective THA, with particular attention to early medical complications and instability-related risk.\u003c/p\u003e "},{"header":"Declarations","content":"\u003ch2\u003eLevels of Evidence\u003c/h2\u003e \u003cp\u003eLevel III\u003c/p\u003e \u003ch2\u003eConsent for Publication\u003c/h2\u003e \u003cp\u003eNot applicable. No individual person\u0026rsquo;s identifiable data are included.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to Participate\u003c/strong\u003e \u003cp\u003eNot applicable. No human participants were directly recruited.\u003c/p\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e \u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eDeclaration\u003c/p\u003e \u003cp\u003eNo external funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eDM: Conceptualization, data extraction, statistical analysis, manuscript drafting.YS: Study design, interpretation of results, critical revision.YB: Conceptualization, supervision, manuscript review and editing.All authors approved the final version.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis study used publicly available data from the HCUP Nationwide Readmissions Database (NRD). Data can be obtained directly from HCUP ( [https://hcup-us.ahrq.gov/dataoverview.jsp](https:/hcup-us.ahrq.gov/dataoverview.jsp) ) upon purchase.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSloan, M., Premkumar, A., Sheth, N. P. \u0026amp; the U.S.. Projected Volume of Primary Total Joint Arthroplasty in, 2014 to 2030. J Bone Joint Surg Am. ;100(17):1455\u0026ndash;1460. doi: 10.2106/JBJS.17.01617. PMID: 30180053. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFasano, A., Canning, C. G., Hausdorff, J. M., Lord, S. \u0026amp; Rochester, L. Falls in Parkinson's disease: A complex and evolving picture. \u003cem\u003eMov. Disord\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e (11), 1524\u0026ndash;1536. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/mds.27195\u003c/span\u003e\u003cspan address=\"10.1002/mds.27195\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017). Epub 2017 Oct 25. PMID: 29067726.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMak, M. K. Y. \u0026amp; Wong-Yu, I. S. K. Exercise for Parkinson's disease. \u003cem\u003eInt. Rev. Neurobiol.\u003c/em\u003e \u003cb\u003e147\u003c/b\u003e, 1\u0026ndash;44. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/bs.irn.2019.06.001\u003c/span\u003e\u003cspan address=\"10.1016/bs.irn.2019.06.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019). Epub 2019 Jun 27. PMID: 31607351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNewman, J. M. et al. Does Parkinson Disease Increase the Risk of Perioperative Complications After Total Hip Arthroplasty? A Nationwide Database Study. J Arthroplasty. ;33(7S):S162-S166. (2018). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2018.01.006\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2018.01.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2018 Jan 16. PMID: 29402715.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eO'Driscoll, C. S., Hughes, A. J., Davey, M. S., Queally, J. M. \u0026amp; O'Daly, B. J. Total Hip Arthroplasty in Patients With Neurological Conditions: A Systematic Review. \u003cem\u003eArthroplast Today\u003c/em\u003e. \u003cb\u003e19\u003c/b\u003e, 101068 (2022). PMID: 36568851; PMCID: PMC9768244.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCourtney, P. M., Boniello, A. J. \u0026amp; Berger, R. A. Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e (5), 1426\u0026ndash;1430. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2016.11.055\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2016.11.055\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017). Epub 2016 Dec 14. PMID: 28034481.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBovonratwet, P. et al. What Are the Reasons and Risk Factors for 30-Day Readmission After Outpatient Total Hip Arthroplasty? J Arthroplasty. ;36(7S):S258-S263.e1. (2021). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2020.10.011\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2020.10.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2020 Oct 15. PMID: 33162278.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMian, H., Lyons, J., Perrin, J., Froehle, A., Krishnamurthy, A. \u0026amp; \u0026amp; \u0026amp; \u0026amp; A review of current practices in periprosthetic joint infection debridement and revision arthroplasty. \u003cem\u003eArthroplasty\u003c/em\u003e \u003cb\u003e4\u003c/b\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s42836-022-00136-5\u003c/span\u003e\u003cspan address=\"10.1186/s42836-022-00136-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTraven, S. A., Reeves, R. A., Slone, H. S. \u0026amp; Walton, Z. J. Frailty Predicts Medical Complications, Length of Stay, Readmission, and Mortality in Revision Hip and Knee Arthroplasty. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e. \u003cb\u003e34\u003c/b\u003e (7), 1412\u0026ndash;1416. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2019.02.060\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2019.02.060\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2019). Epub 2019 Mar 7. PMID: 30930155.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoth, F. L. et al. Impact of Comorbidities on Outcome After Total Hip Arthroplasty. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e. \u003cb\u003e32\u003c/b\u003e (9), 2755\u0026ndash;2761. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2017.04.013\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2017.04.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2017). Epub 2017 Apr 19. PMID: 28506675.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShin, J. I., Keswani, A., Lovy, A. J. \u0026amp; Moucha, C. S. Simplified Frailty Index as a Predictor of Adverse Outcomes in Total Hip and Knee Arthroplasty. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e. \u003cb\u003e31\u003c/b\u003e (11), 2389\u0026ndash;2394. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.arth.2016.04.020\u003c/span\u003e\u003cspan address=\"10.1016/j.arth.2016.04.020\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2016). Epub 2016 Apr 27. PMID: 27240960.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePepper, P. V. \u0026amp; Goldstein, M. K. Postoperative complications in Parkinson's disease. J Am Geriatr Soc. ;47(8):967\u0026thinsp;\u0026ndash;\u0026thinsp;72. (1999). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1532-5415.1999.tb01292.x\u003c/span\u003e\u003cspan address=\"10.1111/j.1532-5415.1999.tb01292.x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 10443858.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTorsney, K. M. \u0026amp; Forsyth, D. Respiratory dysfunction in Parkinson's disease. J R Coll Physicians Edinb. ;47(1):35\u0026ndash;39. (2017). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4997/JRCPE.2017.108\u003c/span\u003e\u003cspan address=\"10.4997/JRCPE.2017.108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 28569280.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePugely, A. J., Martin, C. T., Gao, Y., Schweizer, M. L. \u0026amp; Callaghan, J. J. The Incidence of and Risk Factors for 30-Day Surgical Site Infections Following Primary and Revision Total Joint Arthroplasty. J Arthroplasty. ;30(9 Suppl):47\u0026ndash;50. doi: 10.1016/j.arth.2015.01.063. Epub 2015 Jun 3. PMID: 26071247. (2015).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKonan, S. \u0026amp; Duncan, C. P. Total hip arthroplasty in patients with neuromuscular imbalance. Bone Joint J. ;100-B(1 Supple A):17\u0026ndash;21. (2018). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1302/0301-620X.100B1.BJJ-2017-0571.R1\u003c/span\u003e\u003cspan address=\"10.1302/0301-620X.100B1.BJJ-2017-0571.R1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 29292335; PMCID: PMC6424437.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalker, R. W., Chaplin, A., Hancock, R. L., Rutherford, R. \u0026amp; Gray, W. K. Hip fractures in people with idiopathic Parkinson's disease: incidence and outcomes. \u003cem\u003eMov. Disord\u003c/em\u003e. \u003cb\u003e28\u003c/b\u003e (3), 334\u0026ndash;340. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/mds.25297\u003c/span\u003e\u003cspan address=\"10.1002/mds.25297\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013). Epub 2013 Feb 6. PMID: 23389925.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLazennec, J. Y., Kim, Y. \u0026amp; Pour, A. E. Total Hip Arthroplasty in Patients With Parkinson Disease: Improved Outcomes With Dual Mobility Implants and Cementless Fixation. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e. \u003cb\u003e33\u003c/b\u003e (5), 1455\u0026ndash;1461 (2018). Epub 2017 Dec 5. PMID: 29276118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHall, G. M., Peerbhoy, D., Shenkin, A., Parker, C. J. \u0026amp; Salmon, P. Relationship of the functional recovery after hip arthroplasty to the neuroendocrine and inflammatory responses. Br J Anaesth. ;87(4):537\u0026thinsp;\u0026ndash;\u0026thinsp;42. (2001). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/bja/87.4.537\u003c/span\u003e\u003cspan address=\"10.1093/bja/87.4.537\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 11878721.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTram, M. K. et al. Patient Frailty is Correlated With Increased Adverse Events and Costs After Revision Total Hip Arthroplasty. \u003cem\u003eJ. Arthroplasty\u003c/em\u003e. \u003cb\u003e39\u003c/b\u003e (5), 1151\u0026ndash;1156e4 (2024). Epub 2023 Dec 21. PMID: 38135165.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWainwright, T. W. et al. Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS\u0026reg;) Society recommendations. Acta Orthop. ;91(1):3\u0026ndash;19. doi: 10.1080/17453674.2019.1683790. Epub 2019 Oct 30. Update in: Acta Orthop. 2020;91(3):363. doi: 10.1080/17453674.2020.1724674. PMID: 31663402; PMCID: PMC7006728. (2020).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin, Z., Rismany, J., Gidicsin, C. \u0026amp; Bergese, S. D. Frailty: the perioperative and anesthesia challenges of an emerging pandemic. \u003cem\u003eJ. Anesth.\u003c/em\u003e \u003cb\u003e37\u003c/b\u003e (4), 624\u0026ndash;640. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00540-023-03206-3\u003c/span\u003e\u003cspan address=\"10.1007/s00540-023-03206-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2023). Epub 2023 Jun 13. PMID: 37311899; PMCID: PMC10263381.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Total hip arthroplasty, Parkinson’s disease, Readmission, Revision, Reoperation","lastPublishedDoi":"10.21203/rs.3.rs-8938793/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8938793/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with Parkinson’s disease (PD) undergoing total hip arthroplasty (THA) may be at increased risk for postoperative complications due to neuromuscular dysfunction and medical frailty. Contemporary national data on short-term outcomes following elective primary THA in this population remain limited. This study evaluated index hospitalization complications and 90-day readmission with procedural escalation after elective primary THA in patients with PD.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed a retrospective cohort study using the Nationwide Readmissions Database (2020–2022). Adult patients undergoing elective primary THA on hospital day 0 were identified. A 1:5 propensity score-matched cohort was constructed using demographics, payer, hospital characteristics, calendar year, and comorbidities (all standardized mean differences \u0026lt; 0.1). Index complications, 90-day readmission, and readmission-associated procedural escalation (any procedure, reoperation, and revision) were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe matched cohort included 12,143 elective primary THAs (2,043 PD; 10,100 controls). PD was associated with higher rates of perioperative complications, including blood transfusion, pneumonia, urinary tract infection, and hip dislocation (all p ≤ 0.015), while in-hospital mortality remained low and similar between groups. Within 90 days, PD patients had higher readmission (10.3% vs 5.8%; OR 1.86; p \u0026lt; 0.001) and markedly increased procedural escalation, including reoperation (3.3% vs 0.9%) and revision (3.0% vs 0.7%) (all p \u0026lt; 0.001). Length of stay was longer in PD patients, with no significant difference in hospital charges.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElective primary THA in patients with Parkinson’s disease is associated with increased perioperative complications and substantially higher 90-day readmission with early revision and reoperation. These findings highlight increased post-discharge vulnerability in this population and underscore the need for enhanced perioperative optimization and postoperative surveillance.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLevels of Evidence:\u003c/strong\u003e Level III\u003c/p\u003e","manuscriptTitle":"Elective Total Hip Arthroplasty in Parkinson’s Disease: Increased 90-Day Readmission and Early Procedural Escalation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-23 07:03:01","doi":"10.21203/rs.3.rs-8938793/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"262808634350337207075726866378720546757","date":"2026-05-11T13:45:00+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-19T02:27:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-02T07:21:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-25T10:00:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-25T09:58:58+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2026-02-22T11:24:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"99a92ae5-fc7c-40b4-95a4-67c4c429b118","owner":[],"postedDate":"March 23rd, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"262808634350337207075726866378720546757","date":"2026-05-11T13:45:00+00:00","index":64,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":64888169,"name":"Health sciences/Diseases"},{"id":64888170,"name":"Health sciences/Health care"},{"id":64888171,"name":"Health sciences/Medical research"},{"id":64888172,"name":"Health sciences/Neurology"},{"id":64888173,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-03-23T07:03:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-23 07:03:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8938793","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8938793","identity":"rs-8938793","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}