Declining early mortality after hip and knee arthroplasty

Abstract

Background We aimed to measure the period effect (change over time) in 30‐day mortality after total hip arthroplasty (THA) and total knee arthroplasty (TKA) using data from the Australian Orthopaedic Association National Joint Replacement Registry. Methods We performed an observational study using national registry data from all hospitals performing THA and TKA in Australia including people undergoing primary elective conventional THA and TKA for osteoarthritis from 2003 to 2017, inclusive. Data from the Australian Orthopaedic Association National Joint Replacement Registry, the National Death Index and the Australian Bureau of Statistics were used to generate unadjusted 30‐day mortality, the incident rate ratio for mortality adjusted for age and gender, and the standardized mortality ratio at 30 days for each year separately. Results For the years 2003 and 2017, respectively, for THA, the unadjusted 30‐day mortality was 0.23% and 0.06%, and the standardized mortality ratio was 1.11 (95% CI: 0.73, 1.49) and 0.38 (95% CI: 0.16, 0.59). The incident rate ratio was significantly higher than the reference year (2017) from 2003 to 2010, and for 2012, 2013 and 2016, decreasing over time. For the years 2003 and 2017, respectively, for TKA, the unadjusted 30‐day mortality was 0.17% and 0.08%, and the standardized mortality ratio was 0.84 (95% CI: 0.55, 1.13) and 0.61 (95% CI: 0.38, 0.83). The incident rate ratio was significantly higher than the reference year (2017) from 2003 to 2009 inclusive, decreasing over time. Conclusions Thirty‐day mortality after THA and TKA declined from 2003 to 2017. This may be due to improvements in intra‐operative and post‐operative patient management.

Complications to 6 months following total hip or knee arthroplasty: observations from an Australian clinical outcomes registry

“…At 6 months, all-cause mortality rates were 0.2% for both procedures, which falls within the range of published 30- and 90-day rates of 0.05–1.1% in the US, UK, Australia and Denmark [ 37 – 42 ]. Compared to readmission rates from US Medicare data, we found lower readmission rates at 6 months than the 30-day rates for THA and 90-day rates for TKA [ 8 , 9 , 43 ].…”

Complications to 6 months following total hip or knee arthroplasty: Observations from an Australian clinical outcomes registry

“…At 6 months, all-cause mortality rates were 0.2% for both procedures, which falls within the range of published 30-and 90-day rates of 0.05%-1.1% in the US, UK, Australia and Denmark [37][38][39][40][41][42] . Compared to readmission rates from US Medicare data, we found lower readmission rates at 6 months than the 30-day rates for THA and 90-day rates for TKA 8,9,43 .…”

Improved survival rates after hip fracture surgery in New South Wales, 2011–2018

“…Reductions in 30‐day and 12‐month mortality after hip fracture surgery have also been reported in other countries where guidelines, care standards, and hip fracture audits have been introduced 7,8 . Our findings may also reflect the impact of factors such as improved peri‐ and post‐operative management, as reported for other major orthopaedic procedures 9 . The factors underlying improved survival and their dependence on the care provided, geographic location of patients, and the treating hospital should be further investigated.…”