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Morbidity and Mortality in Elective Total Hip Arthroplasty Following Surgical Care Improvement Project Guidelines
Thomas B Bemenderfer1, Nigel L Rozario2, Charity G Moore3
1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
Insights
The Surgical Care Improvement Project (SCIP) guidelines reduced cardiac complication mortality by 41% in total hip arthroplasty patients. Evidence supports continuing perioperative beta-blockade for hip and knee replacements.
Area of Science:
- Cardiology
- Anesthesiology
- Orthopedic Surgery
Background:
- Perioperative beta-blocker therapy's safety and efficacy were questioned, leading to the retirement of Surgical Care Improvement Project (SCIP) guidelines in 2015.
- Despite guideline changes, perioperative myocardial infarctions and cardiac complications remain significant causes of mortality after noncardiac surgery.
- The impact of SCIP guidelines on cardiac complications in elective total hip arthroplasty (THA) patients was previously unevaluated.
Purpose of the Study:
- To evaluate the impact of the Surgical Care Improvement Project (SCIP) guidelines on reducing cardiac complications in patients undergoing elective total hip arthroplasty (THA).
Main Methods:
- Analysis of 345,875 elective THA cases from the Nationwide Inpatient Sample (2003-2011).
- Assessment of patient demographics, morbidity, and incidence of nonfatal and fatal cardiac complications before and after SCIP guideline implementation.
- Determination of overall mortality associated with cardiac complications.
Main Results:
- A 41% decrease in overall mortality following cardiac complications was observed after SCIP guideline implementation.
- The incidence of nonfatal cardiac events increased by 5%, mainly due to increased nonfatal hypotension.
- Significant reductions were noted in postoperative inpatient mortality, stroke, fatal hypotension, fatal myocardial infarction, and nonfatal/fatal cardiac arrest.
Conclusions:
- Implementation of SCIP guidelines led to a 41% reduction in mortality and decreased fatal cardiac complications, including hypotension, myocardial infarction, and cardiac arrest.
- Despite the 2015 retirement of SCIP guidelines, the findings support the continuation of perioperative beta-blockade for primary elective total adult hip and knee arthroplasty.
- The study highlights the benefits of perioperative beta-blocker therapy in reducing cardiac mortality in THA patients.
Background:
Following evidence questioning the safety and efficacy of perioperative beta-blocker therapy in noncardiac surgery, the Surgical Care Improvement Project (SCIP) guidelines were retired in 2015. However, perioperative myocardial infarctions and cardiac complications remain leading causes of mortality following noncardiac surgery. The impact of the SCIP guidelines on reducing cardiac complications in patients undergoing elective total hip arthroplasty (THA) has not been evaluated.
Methods:
The Nationwide Inpatient Sample was queried for 345,875 elective THA performed from 2003 to 2011. Patient demographics and morbidity as well as the incidence of nonfatal and fatal cardiac complications and overall mortality associated with cardiac complications were determined before and following SCIP implementation.
Results:
Following the institution of the SCIP guidelines, the overall mortality following cardiac complications decreased by 41%. Although the incidence of nonfatal cardiac events after THA did increase 5% (primarily secondary to an increased incidence of nonfatal hypotension), the incidence of postoperative inpatient mortality, stroke, fatal hypotension, fatal myocardial infarction, and nonfatal and fatal cardiac arrest significantly decreased.
Conclusion:
Following the implementation of SCIP guidelines, there was a 41% reduction in mortality and a significant decrease in fatal cardiac complications, postoperative hypotension, myocardial infarction, and cardiac arrest. Despite SCIP guidelines being retired in 2015, evidence supports continuation of perioperative beta-blockade in primary elective total adult hip and knee arthroplasty.