Risk Factors for Perioperative Mortality After Lower Extremity Arthroplasty: A Population-Based Study of 6,901,324 Patient Discharges

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Abstract

The goal of this study was to provide nationally representative data on characteristics of patients who died after hip and knee arthroplasty and to determine risk factors for such outcome. Using national in-patient data collected between 1990 and 2004, we identified a cumulative in-hospital mortality rate of 0.35% among an estimated 6 901 324 procedures. The strongest independent risk factors for in-hospital mortality were pulmonary embolism and cerebrovascular complications, which increased the odds for a fatal outcome by approximately 40-fold. Preoperative risk factors for in-hospital mortality were revision total hip arthroplasty, advanced age, and the presence of a number of comorbid diseases, predominantly dementia, renal, and cerebrovascular disease. Our results can be used to identify patients at risk for fatal outcome and implement interventions to reduce such risk.

Section snippets

The National Hospital Discharge Survey

National Hospital Discharge Survey (NHDS) multiyear data files were obtained from the Centers of Disease Control and Prevention, Atlanta, GA. The plan and operation of the NHDS has been published in detail [6]. In summary, the NHDS includes medical information collected annually since 1965 by the National Center for Health Statistics with the purpose of compiling nationally representative data on in-patient utilization of short-stay hospitals. The hospital universe includes Medicare

Results

An estimated total of 6 901 324 (primary THA 33.16% and revision THA 6.47%; primary TKA 55.50% and revision TKA 4.91%) procedures were performed between 1990 and 2004. During this period, 23 931 (0.35%) patients died during their hospitalization (primary THA 0.32% and revision THA 0.98%; primary TKA 0.30% and revision TKA 0.27%).

Table 1 details patient and health care system–related characteristics of the entire patient population in comparison to those who died in the hospital after surgery.

Discussion

In this study, we were able to characterize the patient population who died during their hospitalization after THA and TKA surgery and compare them to those who had a nonfatal outcome. Furthermore, we identified preoperative and postoperative risk factors for in-hospital mortality. Using data collected over a 15-year period in a nationally representative database, we were able to avoid bias introduced by regional, institutional, and temporal factors.

The overall short-term mortality rate after

Acknowledgment

We would like to thank Ms Licia K. Gaber, BA (LKG Consulting, 24-07 Aspen Drive, Plainsboro, NJ) for her assistance with the writing of program codes.

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  • Cited by (0)

    This study was funded by the Hospital for Special Surgery Anesthesiology Young Investigator Award provided by the Department of Anesthesiology and the Hospital for Special Surgery.

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