Article
Medical complications and inpatient mortality following lower limb arthroplasty in 559,017 patients
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Authors
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Axel Weusten
- The James Cook University Hospital, Middlesbrough, United Kingdom
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Simon Jameson
- The James Cook University Hospital, Middlesbrough, United Kingdom
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Andrew Port
- The James Cook University Hospital, Middlesbrough, United Kingdom
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Philip James
- CHKS Healthcare Intelligence Services, Alcester / Warwickshire, United Kingdom
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Mike Reed
- Wansbeck General Hospital, Ashington, Northumberland, United Kingdom
| Published: | October 23, 2013 |
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Outline
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Objective: Medical complications and death are rare events following elective orthopaedic surgery. Diagnostic and operative codes are routinely collected on every patient admitted to hospital in the English NHS (hospital episode statistics, HES). This is the first study investigating morbidity and mortality following lower limb arthroplasty in the English NHS on a national scale.
Methods: All patients (559017 patients) who underwent hip (THR) or knee arthroplasty (TKR) between March 2005 and February 2010 in all of England were analysed. Patients were subdivided based on Charlson co-morbidity score. 90-day medical complications - myocardial infarction (MI), cerebrovascular event (CVA), chest infection (LRTI), acute renal failure (ARF), and pulmonary embolus (PE) - and inpatient mortality were recorded and analysed.
Results and conclusion: The overall 90-day in-hospital MR after THR was 0.44% (1130 of 256350 patients) and 0.34% (1034 of 302667) after TKR. MI rate was 0.43-0.52%. Of these 14.3% died. LRTI rate was 0.72-0.74%. Of these 12.2% died. RF rate was 0.42-0.48%. Of these 14.1% died. PE rate was 0.65-0.80%. Of these 3.9% died. Patients were more likely to die following LRTI than PE (Odds ratio 3.40 [95% confidence intervals 2.82-4.08]). TKR patients with chronic obstructive pulmonary disease (COPD) were more likely to have a post-operative LRTI than patients without COPD (OR 3.92 [3.36-4.58]). For THR patients, this was higher (OR 4.96 [4.28-5.75]). In patients with no co-morbidities, no personal history of venous thromboembolism, and no post-operative complications (47% of all patients in this study, 261222 of 559017), mortality was only 0.1% (257 patients).
This national data analysis allows a greater understanding of mortality risk following post-operative complications, and provides robust information for the consenting process. Despite the concerns regarding VTE and the high investment in prevention, fatal PE is in fact far less common than mortality after MI, LRTI and RF. This data also shows that the risk of mortality for fit patients without post-operative complications was very low.
