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THR, TKR mortality predictable through vascular risk factors, study finds

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Perioperative mortality during total hip replacement and total knee replacement may be predicted through vascular risk factors, according to researchers in the United Kingdom.

The study results noted a history of myocardial infarction can mean a patient is 20 times more likely to suffer mortality — and thus, these patients should be considered high risk during the perioperative stage.

The findings were presented by S.S. Jameson, MBBS, MRCS, at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011, in Dublin.

“Comorbidities can determine the appropriateness of surgery, however, there is a lack of information on preoperative predictors of perioperative mortality in the literature,” Jameson said. “The aim of this study was to analyze the influence of preoperative risk factors on perioperative mortality involving hip and knee replacement.”

Jameson and his colleagues used the Hospital Episode Statistics database to investigate total hip replacement (THR) and total knee replacement (TKR) cases between 2004 and 2009. Secondary diagnosis codes applied during admission were used to identify independent preoperative predictors of perioperative outcome, with perioperative mortality defined as in-hospital death within 30 days.

Jameson’s team found 591,996 THR and TKR operations were performed during the study period, with 1,334 deaths occurring within 30 days of surgery. For the cases of mortality, myocardial infarction, stroke, heart failure, unstable angina, atrial fibrillation (AF), non-AF arrhythmia, peripheral vascular disease and diabetes mellitus were independent vascular predictors of perioperative mortality.

“In summary, there was a high risk of mortality after renal failure, liver failure, heart failure and cancer,” Jameson said. “For acute coronary syndrome the risk was 1.7 times overall; this was elevated for the first 12 months following the event. Stroke risk was 1.5 times, with no obvious time of effect.”

“Many preexisting comorbidities predict perioperative mortality, and this may be used in the future to stratify risk for individual patients,” he concluded. “[ACS] prior to elective joint replacement surgery should be considered high risk within the first year after the event.”

Reference:

Jameson SS, Bottle A, Aylin P, et al. Independent vascular risk factors predict perioperative mortality in lower limb arthroplasty surgery. Presented at the British Orthopaedic Association and the Irish Orthopaedic Association Combined Meeting 2011. Sept. 13-16. Dublin.

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