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What enhances the in-hospital mortality following total hip arthroplasty? A national inpatient sample-based study

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

With prolonged life expectancy and advancements in prosthetic designs, the proportion of patients belonging to diverse age groups undergoing total hip arthroplasty (THA) has progressively increased. In this context, the details regarding risk factors associated with mortality after THA, and its prevalence need to be clearly understood. This study sought to identify the possible co-morbidities associated with post-THA mortality.

Methods

Based on Nationwide Inpatient Sample (NIS) database, patients undergoing THA from 2016 to 2019 (using ICD-10CMP) were identified. The included cohort was stratified into two groups: “early mortality” and “no mortality” groups. The data regarding patients’ demographics, co-morbidities, and associated complications were compared between the groups.

Results

Overall, 337,249 patients underwent THA, among whom, 332 (0.1%) died during their hospital admission (“early mortality” group). The remaining patients were included under “no mortality” group (336,917 patients). There was significantly higher mortality in the patients, who underwent emergent THA (as compared with elective THA: odd’s ratio 0.075; p < 0.001). Based on multivariate analysis, presence of liver cirrhosis, chronic kidney disease (CKD) and previous history of organ transplant increased the odds of mortality {odds ratio [Exp (B)]} after THA by 4.66- (p < 0.001), 2.37-fold (p < 0.001) and 1.91-fold (p = 0.04), respectively. Among post-THA complications, acute renal failure (ARF), pulmonary embolism (PE), pneumonia, myocardial infarction (MI), and prosthetic dislocation increased the odds of post-THA mortality by 20.64-fold (p < 0.001), 19.35-fold (p < 0.001), 8.21-fold (p < 0.001), 2.71-fold (p = 0.05) and 2.54-fold (p < 0.001), respectively.

Conclusion

THA is a safe surgery with low mortality rate during early post-operative period. Cirrhosis, CKD, and previous history of organ transplant were the most common co-morbidities associated with post-THA mortality. Among post-operative complications, ARF, PE, pneumonia, MI, and prosthetic dislocation substantially enhanced the odds of post-THA mortality.

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Funding

No external source of funding received for this project.

Author information

Authors and Affiliations

  1. Department of Orthopedics, University of Calgary, Calgary, AB, Canada

    Vibhu Krishnan Viswanathan

  2. University of Texas Southwestern, Dallas, TX, USA

    Vikram A. Aggarwal

  3. Pediatric Radiology, Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada

    Surabhi Subramanian

  4. Department of Orthopedics, University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA

    Varatharaj Mounasamy

  5. University of Texas Southwestern, Dallas VAMC, Dallas, TX, USA

    Senthil Sambandam

Authors
  1. Vibhu Krishnan Viswanathan
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  4. Varatharaj Mounasamy
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  5. Senthil Sambandam
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Contributions

VKV—Data processing, Data analysis, reviewing manuscript content, overseeing manuscript preparation and language editing. VAA—Data analysis, writing up manuscript, reviewing and language editing. SS- Data procurement and processing, Data analysis, reviewing manuscript content and language editing. VM—Formulating research methodology, reviewing manuscript content and overseeing manuscript preparation. SS—Conception, formulating research methodology, data procurement and processing, Data analysis, Reviewing manuscript, proof reading and submitting.

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Correspondence to Vibhu Krishnan Viswanathan.

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Viswanathan, V.K., Aggarwal, V.A., Subramanian, S. et al. What enhances the in-hospital mortality following total hip arthroplasty? A national inpatient sample-based study. Arch Orthop Trauma Surg 143, 6423–6430 (2023). https://doi.org/10.1007/s00402-023-04850-w

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  • DOI: https://doi.org/10.1007/s00402-023-04850-w

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