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Scientific Articles   |    
Duration of the Increase in Early Postoperative Mortality After Elective Hip and Knee Replacement
Stein Atle Lie, PhD, MSc1; Nicole Pratt, BSc2; Philip Ryan, MBBS, BSc, FAFPHM2; Lars B. Engesæter, PhD, MD1; Leif I. Havelin, PhD, MD1; Ove Furnes, PhD, MD1; Stephen Graves, MBBS, FRACS, DPhil3
1 Department of Orthopaedic Surgery, The Norwegian Arthroplasty Register, Haukeland University Hospital, N-5021 Bergen, Norway. E-mail address for S.A. Lie: Stein.Lie@unifob.uib.no
2 Discipline of Public Health, Adelaide Health Technology Assessment, The University of Adelaide, SA 5005, Australia
3 AOA National Joint Replacement Registry, Discipline of Public Health, School of Population Health and Clinical Practice, University of Adelaide, SA 5005, Australia
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the Norwegian and Australian governments and the Australian Orthopaedic Association. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
A video supplement to this article will be available from the Video Journal of Orthopaedics. A video clip will be available at the JBJS web site, www.jbjs.org. The Video Journal of Orthopaedics can be contacted at (805) 962-3410, web site: www.vjortho.com.

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jan 01;92(1):58-63. doi: 10.2106/JBJS.H.01882
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Abstract

Background: 

There is increased early postoperative mortality after elective joint replacement surgery. However, the magnitude and duration of the increased mortality are uncertain.

Methods: 

Data on total knee and total hip replacement from the comprehensive national registries in Australia and Norway were assessed. Only patients between fifty and eighty years of age with osteoarthritis were included. Overall, the study included 81,856 patients with a total knee replacement and 106,254 patients with a total hip replacement. Smoothed intensity curves were calculated to show the change in mortality for the early postoperative period, whereas the effects of risk factors were studied with use of the nonparametric additive Aalen model.

Results: 

We found that early postoperative mortality was increased for the first twenty-six postoperative days (95% confidence interval, twenty-two to forty-one days). The excess mortality, compared with a baseline mortality (calculated as the average mortality from Day 100 to Day 200), for these twenty-six days was estimated to be 0.12% (95% confidence interval, 0.11% to 0.14%). The most important risk factors for excessive early postoperative mortality were male sex and high age (more than seventy years of age).

Conclusions: 

There is an increased, but low, early postoperative mortality following lower extremity joint replacement surgery. The excess mortality persists, but steadily decreases, for approximately the first twenty-six postoperative days.

Level of Evidence: 

Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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