Risk Factor Analysis for 30-Day Mortality after Primary THA in a Single Institution

Hidalgo, Ignacio Alonso; Buttaro, Martín; Piccaluga, Francisco

doi:10.1007/s11420-012-9279-7

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…The studies in this review found that an American Society of Anaesthesiologists risk score > 3, 6 , 8 , 14 Charlson co-morbidity index > 3, 8 , 12 , 16 , 21 , 35 use of general anaesthesia, 2 , 8 and prior cardiovascular disease, 9 , 12 , 14 , 16 were risk factors for mortality. Comba et al 14 report that cardiovascular disease increased the risk of mortality eight-fold (odds ratio 8.83; 95% CI 1.78 to 43.6). Studies looking at earlier, peri-operative mortality, have identified pre-existing cardiovascular disease as a strong risk factor for early mortality after THR.…”

Section: What Are the Risk Factors For Mortality?mentioning

confidence: 75%

“…Of the deaths that occurred in this series, ischaemic heart disease accounted for the majority (41.1%), followed by cerebrovascular accidents (23.1%), and pulmonary embolism (11.8%). 49 Of the nine studies in this review reporting cause of mortality, eight identified cardiovascular causes (generally myocardial infarction or heart failure) as the leading cause of death, 7 - 9 , 12 , 14 , 16 , 18 , 28 and in one small study, cerebrovascular accident was the leading cause of death. 33 Cardiovascular disease is repeatedly cited as the leading cause of death following THR in modern series, followed by cerebrovascular disease or fatal pulmonary embolus.…”

Section: What Are the Common Causes Of Mortality?mentioning

confidence: 99%

“… 33 Cardiovascular disease is repeatedly cited as the leading cause of death following THR in modern series, followed by cerebrovascular disease or fatal pulmonary embolus. 8 , 10 , 14 , 23 , 24 , 30 , 34 , 49 - 51 With longer follow-up, other causes such as malignancy, appear to become a significant cause of mortality. 17 …”

Section: What Are the Common Causes Of Mortality?mentioning

confidence: 99%

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Mortality after total hip replacement surgery

Berstock

Beswick

Lenguerrand

et al. 2014

Bone & Joint Research

143

105

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Total hip replacement causes a short-term increase in the risk of mortality. It is important to quantify this and to identify modifiable risk factors so that the risk of post-operative mortality can be minimised. We performed a systematic review and critical evaluation of the current literature on the topic. We identified 32 studies published over the last 10 years which provide either 30-day or 90-day mortality data. We estimate the pooled incidence of mortality during the first 30 and 90 days following hip replacement to be 0.30% (95% CI 0.22 to 0.38) and 0.65% (95% CI 0.50 to 0.81), respectively. We found strong evidence of a temporal trend towards reducing mortality rates despite increasingly co-morbid patients. The risk factors for early mortality most commonly identified are increasing age, male gender and co-morbid conditions, particularly cardiovascular disease. Cardiovascular complications appear to have overtaken fatal pulmonary emboli as the leading cause of death after hip replacement.Cite this article: Bone Joint Res 2014;3:175–82.

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Section: What Are the Risk Factors For Mortality?mentioning

confidence: 75%

Section: What Are the Common Causes Of Mortality?mentioning

confidence: 99%

Section: What Are the Common Causes Of Mortality?mentioning

confidence: 99%

See 1 more Smart Citation

Mortality after total hip replacement surgery

Berstock

Beswick

Lenguerrand

et al. 2014

Bone & Joint Research

143

105

View full text Add to dashboard Cite

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“…The 90-day mortality risk following hip and knee arthroplasty is reported to be 0.2% to 0.3%, only one third of which is attributed to VTE. 49,50 Furthermore, observational data indicate that surgery factors can also impact on mortality risk following hip and knee arthroplasty. For example, the risk of dying is significantly higher following hip arthroplasty compared to knee arthroplasty (3.0% vs. 0.1%).…”

Section: Mortalitymentioning

confidence: 99%

Thromboprophylaxis following hip and knee arthroplasty

Mirkazemi

Bereznicki

Peterson

2013

Internal Medicine Journal

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Aim To determine local thromboprophylaxis prescribing practices following arthroplasty. Methods A retrospective review was performed of 300 consecutive hip and knee arthroplasty patients (150 each) over a 2‐year period at Tasmania's major public hospital. The provision of thromboprophylaxis, the presence of bleeding/thrombotic risk factors and the prevalence of symptomatic venous thromboembolism (VTE) and major bleeding occurring within 90 days postoperatively were documented. Results The mean age of the 300 patients (169 females, 131 males) was 68.7 years (standard deviation 10.4). Only 11.3% of knee arthroplasty and 16.7% of hip arthroplasty inpatients had mechanical thromboprophylaxis documented during their stay. All inpatients received pharmacological thromboprophylaxis, predominantly injectable anticoagulants (98.4%). Only 36.5% continued to receive pharmacological thromboprophylaxis following discharge, predominantly an antiplatelet agent (55.5%). The 90‐day incidence of symptomatic VTE was 2.7% (95% confidence interval: 1.0–5.0%); 4.0% (95% confidence interval: 1.0–8.0%) for knees and 1.3% (95% confidence interval: 0–5.0%) for hips. The in‐hospital and post‐discharge VTE incidence was 0.7% and 2.0% respectively. All readmissions for VTE occurred within 1 month of surgery. Conclusions While inpatient thromboprophylaxis was routine, it generally was not continued on discharge, potentially leaving many patients exposed to a higher risk of VTE. Most cases of symptomatic VTE occurred after discharge, with the majority requiring readmission to hospital under medical units.Within the limitations of a retrospective study, these findings suggest a need for further research and discussion regarding what constitutes appropriate thromboprophylaxis (type, agent and duration) following hip or knee arthroplasty.

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“…Neither the NHFS nor our modified score includes perioperative factors. Whilst these factors, such as pre-operative waiting time, type of femoral implant, prolonged operative time and perioperative anaemia [ 21 – 23 ], are known to influence post-operative outcomes, they are by definition not known at the point of admission to hospital. This is where risk scores such as the NHFS have most clinical utility in informing discussions with the patients regarding outcomes.…”

Section: Discussionmentioning

confidence: 99%

Using pre-fracture mobility to augment prediction of post-operative outcomes in hip fracture

et al. 2023

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Purpose Pre-operative scores based on patient characteristics are commonly used to predict hip fracture outcomes. Mobility, an indicator of pre-operative function, has been neglected as a potential predictor. We assessed the ability of pre-fracture mobility to predict post-operative outcomes following hip fracture. Methods We analysed prospectively collected data from hip fracture surgery patients at a large-volume trauma unit. Mobility was classified into four groups. Post-operative outcomes studied were mortality and residence at 30 days, medical complications within 30- or 60-days post-operatively, and prolonged length of stay (LOS, ≥ 28 days). We performed multivariate regression analyses adjusting for age and sex to assess the discriminative ability of the Nottingham Hip Fracture Score (NHFS), with and without mobility, for predicting outcomes using the area under the receiver operating characteristic curve (AUROC). Results 1919 patients were included, mean age 82.6 (SD 8.2); 1357 (70.7%) were women. Multivariate analysis demonstrated patients with worse mobility had a 1.7–5.5-fold higher 30-day mortality (p ≤ 0.001), and 1.9–3.2-fold higher likelihood of prolonged LOS (p ≤ 0.001). Worse mobility was associated with a 2.3–3.8-fold higher likelihood of living in a care home at 30-days post-operatively (p < 0.001) and a 1.3–2.0-fold higher likelihood of complications within 30 days (p ≤ 0.001). Addition of mobility improved NHFS discrimination for discharge location, AUROC NHFS 0.755 [0.733–0.777] to NHFS + mobility 0.808 [0.789–0.828], and LOS, AUROC NHFS 0.584 [0.557–0.611] to NHFS + mobility 0.616 [0.590–0.643]. Conclusion Incorporating mobility assessment into risk scores may improve casemix adjustment, prognostication following hip fracture, and identify high-risk patient groups requiring enhanced post-operative care at admission.

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Risk Factor Analysis for 30-Day Mortality after Primary THA in a Single Institution

Cited by 8 publications

References 32 publications

Mortality after total hip replacement surgery

Mortality after total hip replacement surgery

Thromboprophylaxis following hip and knee arthroplasty

Using pre-fracture mobility to augment prediction of post-operative outcomes in hip fracture

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