Risk factors for postoperative pulmonary complication (PPC) after total hip arthroplasty (THA) are poorly studied. In addition, the risk factors associated with revision THA may differ from those associated with primary THA. The purpose of this study was to compare the incidences of PPC after revision THA with those observed after primary THA, and to evaluate the risk factors.

We reviewed data describing patients who underwent primary (n = 410) and revision THA (n = 90) during a 10 year study period. The data included age, gender, body mass index, concurrent cardiopulmonary comorbidity, anesthetic techniques, operative time, the number of perioperative transfusions, the amount of fluid replaced, and the American Society of Anesthesiologists physical status. PPCs were grouped together as a single outcome and the incidence and the risk factors for PPC were analyzed.

The incidence of PPC after revision THA was significantly higher than after primary THA (23.3% vs. 11.5%, P = 0.004). The significant risk factors in revision THA were the amount of fluid replaced ≥ 3,000 ml (P = 0.014) and operative time ≥ 180 min (P < 0.001), while there were no risk factors identified by primary THA during univariate analysis. Furthermore, the only significant risk factor identified by multiple logistic regression analysis was operative time (odds ratio = 8.2, P < 0.05).

Patients undergoing revision THA are at higher risk of PPC than primary THA. The operative time is an important factor in the occurrence of PPC after revision THA.