Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the ­Norwegian Arthroplasty Register

Dale, Håvard; Børsheim, Sjur; Kristensen, Torbjørn Berge; Fenstad, Anne Marie; Gjertsen, Jan‐Erik; Hallan, Geir; Lie, Stein Atle; Furnes, Ove

doi:10.1080/17453674.2019.1701312

Cited by 23 publications

(23 citation statements)

References 29 publications

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“…Comparisons of cemented with cementless fixation support the notion that cementation is associated with a very small mortality risk increase, if at all, both in absolute and in relative terms (Dale et al. 2019 , Ekman et al. 2019 ).…”

Section: Discussionmentioning

confidence: 74%

“… 2013 , Dale et al. 2019 ). The true incidence of death secondary to BCIS is unknown in patients undergoing THA due to osteoarthritis, but BCIS seems to be more frequent in elderly patients receiving hemiarthroplasty due to femoral neck fracture compared with elective patients with osteoarthritis receiving THA (Olsen et al.…”

Section: Discussionmentioning

confidence: 99%

“…The Norwegian study on 79,557 patients had access to ASA class, based on physicians’ preoperative assessment of overall health (Dale et al. 2019 ), whereas the Finnish study on 62,221 patients had information on comorbid conditions based on a hospital discharge register (Ekman et al. 2019 ).…”

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confidence: 99%

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Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

et al. 2020

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Background and purpose — Current literature indicates no difference in 90-day mortality after cemented compared with cementless total hip arthroplasty (THA). However, previous studies are hampered by potential selection bias and suboptimal adjustment for comorbidity confounding. Therefore, we examined the comorbidity-adjusted mortality up to 90 days after cemented compared with cementless THA performed due to osteoarthritis. Patients and methods — Using the Nordic Arthroplasty Register Association database, 2005–2013, we included 108,572 cemented and 80,034 cementless THA due to osteoarthritis. We calculated the Charlson comorbidity index of each patient based on data from national patient registers. The Kaplan–Meier method was used to estimate unadjusted all-cause mortality. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for 14, 30-, and 90-day mortality comparing cemented with cementless THA, adjusting for age, sex, comorbidity, nation, and year of surgery. Results — Cumulative all-cause mortality within 90 days was 0.41% (CI 0.37–0.46) after cemented and 0.26% (CI 0.22–0.30) after cementless THA. The adjusted HR for cemented vs. cementless fixation was 0.97 (CI 0.79–1.2), and similar risk estimates were obtained for mortality within 14 (adjusted HR 0.91 [CI 0.64–1.3]) and 30 days (adjusted HR 0.94 [CI 0.71–1.3]). We found no clinically relevant differences in mortality between cemented and cementless THA in analyses stratified by age, sex, Charlson comorbidity index, or year of surgery. Interpretation — After adjustment for comorbidity as an important confounder, we observed similar early mortality between the 2 fixation techniques.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

et al. 2020

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“…The similarity of the calibration plots between the community-based and the clinic-based models also suggest that use of addition of modifiable intervention-related variables, with the exception of knee arthroplasty type, does not add to differential mortality risk prediction above basic demographic factors and comorbidity, as defined here by the ASA score. Although modifiable variables related to the intervention affect mortality at population level, 11 - 13 our findings suggest that their effect size is insufficient to influence outcome for individual decision-making, apart from the choice between unicompartmental or total knee arthroplasty. 17 One possible explanation for this observation is that these variables are associated with patient characteristics and therefore explain a proportion of the variability in the clinic-based model.…”

Section: Discussionmentioning

confidence: 77%

“… 17 One possible explanation for this observation is that these variables are associated with patient characteristics and therefore explain a proportion of the variability in the clinic-based model. 13 , 17 However, these variables do influence other clinical outcomes of interest to patients in the decision-making process that justifies their inclusion in the model. 7 …”

Section: Discussionmentioning

confidence: 99%

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis

Trela-Larsen

Kroken

Bartz‐Johannessen

et al. 2020

Bone & Joint Research

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Aims To develop and validate patient-centred algorithms that estimate individual risk of death over the first year after elective joint arthroplasty surgery for osteoarthritis. Methods A total of 763,213 hip and knee joint arthroplasty episodes recorded in the National Joint Registry for England and Wales (NJR) and 105,407 episodes from the Norwegian Arthroplasty Register were used to model individual mortality risk over the first year after surgery using flexible parametric survival regression. Results The one-year mortality rates in the NJR were 10.8 and 8.9 per 1,000 patient-years after hip and knee arthroplasty, respectively. The Norwegian mortality rates were 9.1 and 6.0 per 1,000 patient-years, respectively. The strongest predictors of death in the final models were age, sex, body mass index, and American Society of Anesthesiologists grade. Exposure variables related to the intervention, with the exception of knee arthroplasty type, did not add discrimination over patient factors alone. Discrimination was good in both cohorts, with c-indices above 0.76 for the hip and above 0.70 for the knee. Time-dependent Brier scores indicated appropriate estimation of the mortality rate (≤ 0.01, all models). Conclusion Simple demographic and clinical information may be used to calculate an individualized estimation for one-year mortality risk after hip or knee arthroplasty ( https://jointcalc.shef.ac.uk ). These models may be used to provide patients with an estimate of the risk of mortality after joint arthroplasty. Cite this article: Bone Joint Res 2020;9(11):808–820.

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Prediction of Early Adverse Events After THA: A Comparison of Different Machine‐Learning Strategies Based on 262,356 Observations From the Nordic Arthroplasty Register Association (NARA) Dataset

Venäläinen,

Panula,

Eskelinen

et al. 2024

ACR Open Rheumatology

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ObjectivePreoperative risk prediction models can support shared decision‐making before total hip arthroplasties (THAs). Here, we compare different machine‐learning (ML) approaches to predict the six‐month risk of adverse events following primary THA to obtain accurate yet simple‐to‐use risk prediction models.MethodsWe extracted data on primary THAs (N = 262,356) between 2010 and 2018 from the Nordic Arthroplasty Register Association dataset. We benchmarked a variety of ML algorithms in terms of the area under the receiver operating characteristic curve (AUROC) for predicting the risk of revision caused by periprosthetic joint infection (PJI), dislocation or periprosthetic fracture (PPF), and death. All models were internally validated against a randomly selected test cohort (one‐third of the data) that was not used for training the models.ResultsThe incidences of revisions because of PJI, dislocation, and PPF were 0.8%, 0.4%, and 0.3%, respectively, and the incidence of death was 1.2%. Overall, Lasso regression with stable iterative variable selection (SIVS) produced models using only four to five input variables but with AUROC comparable to more complex models using all 32 variables available. The SIVS‐based Lasso models based on age, sex, preoperative diagnosis, bearing couple, fixation, and surgical approach predicted the risk of revisions caused by PJI, dislocations, and PPF, as well as death, with AUROCs of 0.61, 0.67, 0.76, and 0.86, respectively.ConclusionOur study demonstrates that satisfactory predictive potential for adverse events following THA can be reached with parsimonious modeling strategies. The SIVS‐based Lasso models may serve as simple‐to‐use tools for clinical risk assessment in the future.

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Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register

Cited by 23 publications

References 29 publications

Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis

Prediction of Early Adverse Events After THA: A Comparison of Different Machine‐Learning Strategies Based on 262,356 Observations From the Nordic Arthroplasty Register Association (NARA) Dataset

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Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the ­Norwegian Arthroplasty Register

Cited by 23 publications

References 29 publications

Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

Similar early mortality risk after cemented compared with cementless total hip arthroplasty for primary osteoarthritis: data from 188,606 surgeries in the Nordic Arthroplasty Register Association database

Personalized estimation of one-year mortality risk after elective hip or knee arthroplasty for osteoarthritis

Prediction of Early Adverse Events After THA: A Comparison of Different Machine‐Learning Strategies Based on 262,356 Observations From the Nordic Arthroplasty Register Association (NARA) Dataset

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Perioperative, short-, and long-term mortality related to fixation in primary total hip arthroplasty: a study on 79,557 patients in the Norwegian Arthroplasty Register