High-volume revision THA centers associated with lower rate of in-hospital mortality
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Septic revision total hip arthroplasty was associated with lower risk of in-hospital mortality when performed at a high-volume revision center vs. a low-volume center, according to a study published in Orthopedics.
“We found an in-hospital mortality rate of 5.2% at a follow-up period of 2 years for patients undergoing septic revision THA, with low-volume hospitals having significantly higher rates of mortality,” Linsen T. Samuel, MD, MBA, and colleagues wrote.
Samuel and colleagues used the Healthcare Cost and Utilization Project State Inpatient Databases of New York and Florida to identify 3,970 cases of septic revision THA (rTHA) from 2007 to 2012. The researchers also analyzed a matched cohort of 257,420 patients who underwent primary THA and a cohort of 23,490 patients who underwent aseptic rTHA.
Outcomes were measured at 2-year follow-up and included in-hospital mortality rate, the effect of hospital hip revision surgery volume (HRV) on mortality and independent risk factors associated with in-hospital mortality.
Overall, 5.2% of patients who underwent septic rTHA, 2.9% who underwent primary THA and 2.1% who underwent aseptic rTHA died.
Samuel and colleagues found that patients who underwent rTHA at a high-HRV hospital had a statistically significantly lower odds ratio of in-hospital mortality (adjusted OR = 0.539; 95% CI, 0.332-0.87) compared with patients who underwent rTHA at a low-HRV hospital (P = .0127). Additionally, they found older age and greater comorbidity burden were both independently associated with increased 2-year postoperative mortality.
“Future studies should explore methods to reduce the risk of mortality, especially for patients undergoing septic rTHA in low-HRV hospitals, with further analysis of adding complex orthopedic procedures to volume-outcome recommendations,” Samuel and colleagues wrote. “Additionally, we recommend prioritizing high-HRV centers for septic rTHA and using risk stratification when reporting in-hospital mortality rates after septic rTHA.”
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