Mortality after total hip replacement surgery

Berstock, James R; Beswick, Andrew D; Lenguerrand, Erik; Whitehouse, Michael R; Blom, Ashley W

doi:10.1302/2046-3758.36.2000239

Cited by 143 publications

(121 citation statements)

References 68 publications

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“…16,17 We found that in our cohort, the NSQIP-ACS risk calculator 18 had underestimated mortality considerably for patients with the demographics and comorbidities found in our sample. The calculator predicted average mortality of 12% for emergency and 7% for nonemergency hip fracture surgery.…”

Section: Discussionmentioning

confidence: 65%

Comparison of Postoperative Outcomes in Elderly Patients With a Do-Not-Resuscitate Order Undergoing Elective and Nonelective Hip Surgery

Beverly

Brovman

Urman

2017

Geriatr Orthop Surg Rehabil

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Purpose:Emergency hip surgery generally has worse outcomes than elective hip surgery, even when adjusted for patient and surgical factors. Do-not-resuscitate (DNR) status patients are typically at higher perioperative risk and undergo a narrow range of surgical procedures. We aimed to compare the outcomes after hip surgery of differing degrees of urgency in this cohort.Materials and Methods:Using National Surgical Quality Improvement Program (NSQIP) data, we conducted univariate and multivariate analyses comparing outcomes of DNR status patients after emergency and nonemergency hip surgery (2007-2013). We conducted a subanalysis of mortality in elective versus nonelective cases (elective variable introduced from 2011).Results:Of 668 hip surgery cases in DNR status patients, 210 (31.4%) were emergency and 458 (68.8%) were nonemergency. There were no significant associations between emergency and nonemergency surgery regarding patient demographics, comorbidities, functional capacity, anesthesia type, or operative duration. There was no significant difference in the 30-day postoperative mortality between emergency (21.4%) and nonemergency (16.4%) or between elective (19.6%) and nonelective (18.3%) hip fracture surgeries performed in patients with preexisting DNR status. Morbidity patterns in emergency vs nonemergency cases demonstrated no significant differences, with the commonest 3 complications being transfusion (21.0% and 21.4%, respectively), urinary tract infection (9.5% and 7.9%, respectively), and pneumonia (both at 5.2%). The 30-day home discharge rates were low at 4.7% and 5.6%, respectively. Multivariate analysis demonstrated no significant associations between emergency and nonemergency surgery for mortality, discharge destination, length of stay or complications, except perioperative myocardial infarction (3.7% vs 1.3%, P < .04).Conclusion:For patients with DNR status, both emergent and non-emergent hip surgery carries high mortality, greatly exceeding rates predicted for that patient by American College of Surgeons NSQIP risk calculators. Morbidity rates and patterns for patients with DNR status are also similar in emergency and nonemergency groups. These data may be useful in discussing risk and obtaining adequately informed consent in DNR patients undergoing hip surgery.

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Section: Discussionmentioning

confidence: 65%

Comparison of Postoperative Outcomes in Elderly Patients With a Do-Not-Resuscitate Order Undergoing Elective and Nonelective Hip Surgery

Beverly

Brovman

Urman

2017

Geriatr Orthop Surg Rehabil

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“…This mechanism may also be a contributing factor for the observation of lower mortality risk among low-to-moderate consumers because cardiovascular diseases are reported to be a frequent cause of death after hip arthroplasty [39]. …”

Section: Discussionmentioning

confidence: 99%

Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

et al. 2017

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ObjectiveTo investigate the implications of low and moderate preoperative alcohol consumption on postoperative mortality and morbidity after primary hip and knee arthroplasty.MethodsA total of 30,799 patients who underwent primary hip or knee arthroplasty between January 1st, 2005 and October 8th, 2011 with information on preoperative alcohol consumption (0 grams of pure alcohol/week, >0–168 g/week, >168–252 g/week, and >252 g/week) were identified through the Danish Anesthesia Database. The 90-day and 1-year risks of mortality (primary outcomes), 1-year risk of prosthetic infection, and 30-day risks of cardiovascular disease and deep venous thrombosis (secondary outcomes) were estimated by Cox regression analysis.ResultsWe identified 285 (0.9%) deaths within the first 90 days and 694 (2.3%) within the first year. Within the first 30 days, 209 (0.7%) and 270 (0.9%) patients had acquired cardiovascular disease and deep venous thrombosis, respectively, and 514 (1.7%) patients developed prosthetic infection within the first year. The adjusted mortality models yielded hazard ratios of 0.55 (95% confidence interval [CI] 0.41 to 0.74) at 90 days and 0.61 (95% CI 0.51 to 0.73) at 1 year for the group consuming >0–168 g/week when compared to abstainers. Adjusted hazard ratios showed that the group consuming >0–168 g/week had a 0.91 (95% CI 0.75 to 1.11) risk of prosthetic infection, 0.68 (95% CI 0.50 to 0.92) risk of cardiovascular disease and 0.88 (95% CI 0.67 to 1.15) risk of deep venous thrombosis when compared to abstainers.ConclusionsThis study demonstrates that low-to-moderate alcohol consumption prior to primary hip or knee arthroplasty is associated with lower risks of mortality at both 90 days and 1 year after surgery and of cardiovascular disease after 30 days. More research from longitudinal studies is needed to identify specific causal relations and explanations.

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“…There is also a small mortality risk. 43,44 BACKGROUND TO THE RESTORE PROGRAMME NIHR Journals Library www.journalslibrary.nihr.ac.uk Attention has turned in recent years towards patient-reported outcomes in addition to technical outcomes. 45 Studies using patient-reported outcome measures (PROMs) suggest that mean pain and function scores after initial recovery from surgery are generally good.…”

Section: The Outcomes Of Hip and Knee Joint Replacementmentioning

confidence: 99%

“…43 Research in patients receiving a THR with comorbid cardiovascular disease has mainly focused on adverse events after surgery.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

Blom

Artz

Beswick

et al. 2016

Programme Grants Appl Res

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms PROGRAMME GRANTS FOR APPLIED RESEARCH VOLUME 4 ISSUE 12 AUGUST 2016 ISSN 2050 DOI 10.3310/pgfar04120Improving patients' experience and outcome of total joint replacement: the RESTORE programme Ashley W Blom, Neil Artz, Andrew D Beswick, Amanda Burston, Paul Dieppe, Karen T Elvers, Rachael Gooberman-Hill, Jeremy Horwood, Paul Jepson, Emma Johnson, Erik Lenguerrand, Elsa Marques, Sian Noble, Mark Pyke, Catherine Sackley, Gina Sands, Adrian Sayers, Victoria Wells and Vikki Wylde Improving patients' experience and outcome of total joint replacement: the RESTORE programme ISSN 2050-4330 (Online) This journal is a member of and subscribes to the principles of the Committee on Publication Ethics (COPE) (www.publicationethics.org/).Editorial contact: nihredit@southampton.ac.ukThe full PGfAR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/pgfar. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Programme Grants for Applied Research journalReports are published in Programme Grants for Applied Research (PGfAR) if (1) they have resulted from work for the PGfAR programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors. Programme Grants for Applied Research programmeThe Programme Grants for Applied Research (PGfAR) programme, part of the National Institute for Health Research (NIHR), was set up in 2006 to produce independent research findings that will have practical application for the benefit of patients and the NHS in the relatively near future. The Programme is managed by the NIHR Central Commissioning Facility (CCF) with strategic input from the Programme Director.The programme is a national response mode funding scheme that aims to provide evidence to improve health outcomes in England through promotion of health, prevention of ill health, and optimal disease management (including safety and quality), with particular emphasis on conditions causing significant disease burden.For more information about the PGfAR programme please visit the website: http://www.nihr.ac.uk/funding/programme-grants-forapplied-research.htm This reportThe research reported in this issue of the journal was funded by PGfAR as project number RP-PG-0407-10070. The contractual start date was in December 2008. The final report began editorial review in September 2014 and was accepted for publication in August 2015. As the funder, the PGfAR programme agreed the research questions and study designs in advance with the investigators. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The PGfAR editors and production house have tried to ensure the accurac...

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Mortality after total hip replacement surgery

Cited by 143 publications

References 68 publications

Comparison of Postoperative Outcomes in Elderly Patients With a Do-Not-Resuscitate Order Undergoing Elective and Nonelective Hip Surgery

Comparison of Postoperative Outcomes in Elderly Patients With a Do-Not-Resuscitate Order Undergoing Elective and Nonelective Hip Surgery

Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty – A register-based cohort study

Improving patients’ experience and outcome of total joint replacement: the RESTORE programme

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