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No differences in early mortality between simultaneous and staged bilateral surgery
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Results of a recently published study showed there were no clinically relevant differences in early postoperative mortality among healthy patients who underwent simultaneous bilateral surgery vs. those who underwent staged bilateral surgery.
Researchers observed 42,238 patients from the Swedish Hip Arthroplasty Register who underwent either simultaneous bilateral total hip arthroplasty (THA) or staged bilateral THA.
The time interval between the first and second surgery was either considered a continuous variable or was split into four different categories: simultaneous bilateral surgery, surgery in 6 months or less, surgery between 7 and 12 months, and surgery at greater than 12 months. Following the second surgery, the researchers observed mortality rates at 30 days, 90 days, 10 years and overall, with a primary study endpoint of 90-day mortality. The researchers used Kaplan-Meier survival analysis to calculate unadjusted survival, and adjusted Cox regression models were then used to calculate crude and adjusted hazard ratios at each follow-up time point.
Results showed after the second surgery, 63 patients died within 30 days, 125 patients died within 90 days and 6,178 patients died within 10 years.
According to the researchers, patients who received simultaneous bilateral surgery differed from those who received staged surgery in that they were more often male, younger and had a lower American Society of Anesthesiologists (ASA) class. Osteoarthritis was the most common diagnosis, but rheumatoid arthritis (RA) was more common in the simultaneous bilateral surgery group vs. the staged bilateral surgery group.
The 90-day mortality increased when patients were older, men, had a ASA class of 3 or above, or had RA, according to the researchers.
Patients who received simultaneous bilateral surgery had a higher risk of hip implant revision within 1-year compared with patients who received staged bilateral surgery; however, these findings were not considered significant after adjusting for age, gender, diagnosis and implant fixation, according to the researchers.‒ by Monica Jaramillo
Disclosures: Researchers report no relevant financial disclosures.
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