Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013-2022

J Magnusson; J Karlsson; O Sköldenberg; J Albert; C Frostell; J G Jakobsson

doi:10.1186/s13018-024-04752-6

Difference in early all-cause mortality among patients having hip arthroplasty a Swedish perioperative registry study 2013-2022

J Orthop Surg Res. 2024 May 15;19(1):295. doi: 10.1186/s13018-024-04752-6.

Authors

J Magnusson¹, J Karlsson^{2

3}, O Sköldenberg⁴, J Albert⁵, C Frostell⁵, J G Jakobsson⁶

Affiliations

¹ Karolinska Institutet, Stockholm, Sweden.
² Sahlgrenska Academy, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.
³ Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Unit of Orthopaedics, Department of clinical sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
⁵ Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden.
⁶ Department of clinical sciences at Danderyd Hospital, Unit of Anaesthesia and Intensive Care, Karolinska Institutet, Stockholm, SE-182 88, Sweden. Jan.Jakobsson@ki.se.

Abstract

Introduction: Hip arthroplasty is a common orthopaedic procedure worldwide. There is an ongoing debate related to the fixation and anaesthesia impact on the 30-day mortality, particularly in the aging population with higher American Society of Anaesthesiology (ASA) Physical-Status.

Aim: To study the 30-day all-cause mortality in patients undergoing primary hip arthroplasty, with regards to the impact of age, ASA-class, anaesthesia techniques, indication for surgery and fixation techniques.

Materials and methods: Perioperative data for primary hip arthroplasty procedures for osteoarthritis and hip fractures registered in the Swedish Perioperative Registry (SPOR) between 2013 and June 2022 were collected. Binary logistic regressions were performed to assess the impact of age, ASA-class, anaesthetic technique, indication for surgery and fixation on odds ratio for 30-day mortality in Sweden.

Results: In total, 79,114 patients, 49,565 with osteoarthritis and 29,549 with hip fractures were included in the main study cohort. Mortality was significantly higher among hip fracture patients compared with osteoarthritis, cumulative 8.2% versus 0.1% at 30-days respectively (p < 0.001). Age above 80 years (OR3.7), ASA 3-5 (OR3.3) and surgery for hip fracture (OR 21.5) were associated with significantly higher odds ratio, while hybrid fixation was associated with a significantly lower odds ratio (OR0.4) of 30-day mortality. In the same model, for the subgroups of osteoarthritis and hip fracture, only age (OR 3.7) and ASA-class (OR 3.3) had significant impact, increasing the odds ratio for 30-day mortality. Hemi arthroplasty was commonly used among the hip fracture patients 20.453 (69.2%), and associated with a significantly higher odds ratio for all-cause 30-day mortality as compared to total hip arthroplasty when adjusting for age and ASA-class and fixation 2.3 (95%CI 1.9-2.3, p < 0.001).

Conclusions: All-cause 30-day mortality associated with arthroplasty differed significantly between the two cohorts, hip fracture, and osteoarthritis (8.2% and 0.1% respectively) and mortality expectedly increased with age and higher ASA-class. Anaesthetic method and cement-fixation did not impact the odds ratio for all-cause 30-day mortality after adjustment for age and ASA-class.

Keywords: ASA-class; Anaesthesia; Cemented; Cementless; Early mortality; Fracture; Hip arthroplasty.

MeSH terms

Age Factors
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip* / mortality
Cohort Studies
Female
Hip Fractures* / mortality
Hip Fractures* / surgery
Humans
Male
Middle Aged
Osteoarthritis, Hip* / mortality
Osteoarthritis, Hip* / surgery
Registries*
Sweden / epidemiology
Time Factors