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Several comorbidities linked with greater early post-TJA mortality
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Ischemic heart disease was the main cause of death 90 days following total joint replacement performed for osteoarthritis according to a recently published study. However, results showed postoperative deaths associated with digestive system-related disease increased, as well.
“We know we are practicing safe surgery; however, if there are some initiatives to improve matters further, then [we should] possibly look more closely at ischemic heart disease and for [gastrointestinal] GI complications,” Martyn L. Porter, FRCS, of the Centre for Hip Surgery at Wrightington Hospital in the United Kingdom, told Orthopedics Today.
Porter and colleagues studied causes and rates of mortality among 332,734 patients who underwent total hip arthroplasty (THA) and 384,291 patients who underwent total knee arthroplasty (TKA) based on records in the National Joint Registry for England, Wales, Northern Island and the Isle of Man (NJR) and compared them with age- and sex-matched individuals in the general population.
Results showed main causes of death after total joint replacement (TJR) included malignant neoplasms, circulatory system disorders, respiratory system disorders and digestive system diseases. Compared with the general population, researchers found a relative 39% reduction in mortality among patients who underwent THA, which equalized to the rate in the general population by 7 years. The relative 43% reduction found for patients who underwent TKA partially attenuated by 7 years, but did not equalize to the rate of the general population.
Ischemic heart attack was the most common cause of death within 90 days, researchers found. Their results showed the risk of death within 90 days postoperatively was elevated by circulatory, respiratory and digestive system-related causes, but this was not the case in the 91-day to 1-year postoperative period.
According to Porter, who is NJR medical director and vice chairman, the large number of patients studied made it possible to identify GI complications as a risk of mortality in these short-term results.
Future research should focus on identifying strategies to reduce the risk of mortality among patients with ischemic heart disease or digestive system-related complications who undergo TJR, he said.
“One of the questions this paper raises is we should think about these two specific issues in relation to potentially reducing mortality even further,” Porter said. “The question is: Can it be done? In other words, can we modify these risk factors or do we just have to accept them as risk factors and just go ahead with the procedure. Is there anything else we can do in the preoperative, perioperative or postoperative period to further protect patients from succumbing to these potential risks for death?” – by Casey Tingle
- Reference:
- Hunt LP, et al. J Bone Joint Surg Am. 2017;doi:10.2106/JBJS.16.00586.
- For more information:
- Martyn L. Porter, FRCS, can be reached at Hall Lane, Appley Bridge, Wrightington, Lancashire WN6 9EP, United Kingdom; email: martynporter@hipkneeclinic.com.
Disclosure: Porter reports no relevant financial disclosures.