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Early postoperative mortality after simultaneous or staged bilateral primary total hip arthroplasty: an observational register study from the swedish Hip arthroplasty register
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Visby Hosp, Dept Orthopaed, Visby, Sweden; Swedish Hip Arthroplasty Register, Gothenburg, Sweden.
Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden; Harvard Univ, Massachusetts Gen Hosp, Sch Med, Harris Orthopaed Lab, Boston, MA 02115 USA.
Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden.
Swedish Hip Arthroplasty Register, Gothenburg, Sweden; Univ Gothenburg, Sahlgrenska Acad, Inst Clin Sci, Dept Orthopaed, Gothenburg, Sweden.
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2015 (English)In: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 16, 77Article in journal (Refereed) Published
Abstract [en]

Background: Approximately a fifth of all total hip arthroplasty (THA) patients suffers from bilateral osteoarthritis of the hip. It is unclear whether mortality risks differ between simultaneous bilateral THA and staged bilateral THA. We investigated mortality after simultaneous THA compared with staged bilateral THA in the largest cohort hitherto reported. Methods: The 42,238 patients reported to have received bilateral primary THA from 1992 to 2012 in the Swedish Hip Arthroplasty Register were included. Tumours and fractures as underlying diagnoses were excluded. The time interval between the first and second THA was divided into four categories or treated as a continuous variable. Unadjusted survival was calculated according to Kaplan-Meier and adjusted Cox regression models were fitted in order to calculate crude and adjusted hazard ratios (HR) for the risk of death within different time frames. Results: Patients selected for simultaneous bilateral surgery were younger, more often male, and had lower ASA (American Society of Anesthesiologists) class than patients receiving staged procedures. The adjusted 90-day mortality after the second procedure did not differ between the four investigated groups (simultaneous bilateral [HR 1.3, CI 0.5-3.3], surgeries within 6 months [HR 1.1, CI 0.6-2.0], surgeries between 7 and 12 months [HR 0.7, CI 0.4-1.2], with second surgery after > 12 months as the reference group). For patients older than 75 years, men, patients with ASA class 3 or above, and for patients with rheumatoid arthritis (RA) the 90-day mortality was increased. The unadjusted risk of implant revision of any hip was slightly higher for patients with simultaneous bilateral THA compared to those with staged procedure within one year, but after adjustment for age, gender, diagnosis and implant fixation these differences were no longer statistically significant. Conclusion: There were no clinically relevant differences in early postoperative mortality between simultaneous and staged bilateral surgery in healthy patients. Advanced age, RA, a high ASA class and male sex increased the risk of death within 90 days. There may be an issue with enhanced risk of implant revision in patients with simultaneous bilateral THA that needs to be explored further.

Place, publisher, year, edition, pages
2015. Vol. 16, 77
Keyword [en]
Postoperative mortality, Perioperative mortality, Simultaneous bilateral total hip arthroplasty, Register, Registry, Total hip replacement, One-stage bilateral THR/THA, Two-stage bilateral THR/THA
National Category
Orthopedics
Identifiers
URN: urn:nbn:se:uu:diva-252170DOI: 10.1186/s12891-015-0535-0ISI: 000352609400001PubMedID: 25887667OAI: oai:DiVA.org:uu-252170DiVA: diva2:810193
Note

Erratum in BMC Musculoskeletal Disorders 2015:16, 263, doi:10.1186/s12891-015-0717-9.

Available from: 2015-05-06 Created: 2015-05-04 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Early Mortality After Total Hip Arthroplasty In Sweden
Open this publication in new window or tab >>Early Mortality After Total Hip Arthroplasty In Sweden
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Every year 16 000 individuals receive a total hip arthroplasty (THA) in Sweden. Even though THA is a common procedure, adverse events do occur. The most dramatic complication is death in the postoperative phase. The overall aim of this thesis was to describe and investigate early mortality after THA in Sweden.

Sweden has an ideal platform for national observational registry studies, thanks to the use of personal identity numbers. Operation-specific information was collected from the Swedish Hip Arthroplasty Register, medical information from the National Board of Health and Welfare, and socioeconomic information was collected from Statistics Sweden. Main outcome was 90-day mortality.

Study I was a prospective observational register study investigating the risk of mortality after a simultaneous bilateral THA compared with staged bilateral THA. There was no clinically relevant difference in early postoperative mortality between the two groups.

Studies II and III were nation-wide matched cohort studies, with adjustment for comorbidity and socioeconomic background. Adjusted early mortality in femoral neck fracture patients receiving a THA is about double compared with a matched control population. Young (60-69 years) femoral neck fracture patients receiving a THA have a low absolute mortality risk, while those who are older than 80 years with a higher degree of medical comorbidity run a high risk of early death (II). In study III healthier, younger patients with higher socioeconomic status tended to be selected for cementless THA, resulting in selection bias. Even after accounting for this bias, however, there remains a small absolute and adjusted increase in the risk of death within 14 days after elective THA surgery using fully cemented implants.

Study IV was a nationwide prospective cohort study comparing different comorbidity measures in terms of predicting early postoperative mortality after THA. A less data-demanding comorbidity measure is better at predicting 90-day mortality than more commonly used coding algorithms.

In conclusion, socioeconomic background and the presence of comorbidities have an important influence on early mortality after THA, while the type of fixation is of less importance. Future mortality studies could benefit from the use of data that are routinely collected, and thus avoid the logistically complicated procedure now necessary to merge national databases.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. 63 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1309
Keyword
early mortality, total hip replacement, total hip arthroplasty, comorbidity, socioeconomic factor, cemented
National Category
Medical and Health Sciences
Research subject
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-316989 (URN)978-91-554-9842-9 (ISBN)
Public defence
2017-04-29, Linnésalen, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (English)
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Supervisors
Available from: 2017-04-07 Created: 2017-03-08 Last updated: 2017-04-21

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Garland, AnneHailer, Nils P.

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