Decreasing trend of inpatient mortality rates of aseptic versus septic revision total hip arthroplasty: an analysis of 681,034 cases

Abstract

Background: While most revision total hip arthroplasties (rTHAs) are for aseptic loosening/instability, infection accounts for approximately 16%. The purpose of this study was to: (1) quantify mortality rates of aseptic versus septic rTHA; (2) determine if mortality rates have changed over the past 20 years; and (3) identify associated preoperative risk factors, focusing on the utility/validity of the Elixhauser comorbidity index (ECI). Methods: ICD-9/ICD-10 codes were used to identify patients undergoing rTHA in the National Inpatient Sample database between 1998 and 2017. A total of 681,034 cases (576,143 aseptic THA and 104,891 septic THA) were identified. For each patient, demographic variables including age, sex, race, insurance type, ECI, and inhospital mortality were gathered. A logistic regression model was constructed to assess risk of inhospital mortality. Results: From 1998 to 2017, inpatient mortality rates of aseptic and septic rTHA decreased from 0.83 to 0.45%, and from 2.58 to 1.24%, respectively. Septic rTHA was independently associated with higher odds of mortality relative to aseptic (odds ratio (OR): 2.305, 95% confidence interval (CI): (2.014, 2.638), p < 0.0001). Increased ECI was associated with higher odds of mortality at both medium (OR: 5.147, 95% CI: (4.433,5.977), p < 0.0001) and high index scores (OR: 13.714, 95% CI: (11.519,16.326), p < 0.0001). Conclusions: Mortality rates for both aseptic and septic rTHA have been declining over the past 20 years, potentially due to patient selection guidelines and advances in medical management. Our study confirms that the ECI is independently associated with increased inpatient mortality.

Hip & Pelvis

“…This paper from New York (New York, USA) sets out to establish what the mortality burden is carried by different indications for revision surgery. 6 They used the National Inpatient Sample conducted between 1998 and 2017, providing a huge sample of revision procedures with a total of 681,034 cases (576,143 aseptic total hip arthroplasties (THAs) and 104,891 septic THAs). The study called for extraction of a range of demographics (age, sex, race, insurance type) and outcome data (including mortality).…”

Detection of Prosthetic Loosening in Hip and Knee Arthroplasty Using Machine Learning: A Systematic Review and Meta-Analysis

“…The most common causes of revision TKA are infection and aseptic loosening; the rate of aseptic loosening has increased recently [16][17][18][19]. In revision THA, infection and aseptic loosening also account for the largest proportion of revision surgeries [20][21][22]. As the diagnosis of prosthetic loosening is still challenging, various imaging tools are used for diagnosis, including plain radiographs, scintigraphy, arthrograms, fluorodeoxyglucosepositron emission tomography (FDG-PET) scans, and MRI [23,24].…”