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In-hospital mortality after hip arthroplasty in China: analysis of a large national database
Chao Zeng1,2,3, Nancy E Lane4, Martin Englund5
1Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
Insights
In-hospital mortality after hip arthroplasty in China decreased between 2013 and 2016. However, older age, male sex, and comorbidities increased mortality risk, with regional disparities also noted.
Area of Science:
- Orthopedic surgery
- Public health
- Epidemiology
Background:
- Hip arthroplasty demand is rising in China.
- Understanding in-hospital mortality trends and risk factors is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze trends in in-hospital mortality following hip arthroplasty in China.
- To identify sociodemographic and clinical risk factors associated with mortality.
Main Methods:
- Analysis of 210,450 primary hip arthroplasty cases from China's Hospital Quality Monitoring System (2013-2016).
- Multivariable Poisson regression was used to assess mortality and risk factors.
- In-hospital mortality within 30 days was the primary outcome measure.
Main Results:
- Overall in-hospital mortality decreased from 2.9% in 2013 to 2.6% in 2016.
- Increased mortality risk was associated with older age, male sex, and divorced/widowed status.
- Arthroplasty for fracture, higher Charlson Comorbidity Index (CCI) scores (1-2 and ≥3), and certain geographical regions (North-West, North-East) showed significantly higher mortality risks.
Conclusions:
- In-hospital mortality after hip arthroplasty in China is low and declining.
- Significant disparities in mortality exist based on sociodemographic factors and region.
- Targeted healthcare resource allocation to underdeveloped regions may further reduce mortality.
Aims:
There is an increasing demand for hip arthroplasty in China. We aimed to describe trends in in-hospital mortality after this procedure in China and to examine the potential risk factors.
Patients And Methods:
We included 210 450 patients undergoing primary hip arthroplasty registered in the Hospital Quality Monitoring System in China between 2013 and 2016. In-hospital mortality after hip arthroplasty and its relation to potential risk factors were assessed using multivariable Poisson regression.
Results:
During the study period, 626 inpatient deaths occurred within 30 days after hip arthroplasty. Mortality decreased from 2.9% in 2013 to 2.6% in 2016 (p for trend = 0.02). Compared with their counterparts, old age, male sex, and divorced or widowed patients had a higher rate of mortality (all p < 0.05). Risk ratio (RR) for mortality after arthroplasty for fracture was two-fold higher (RR 2.0, 95% confidence interval (CI) 1.5 to 2.6) than that for chronic disease. RRs for mortality were 3.3 (95% CI 2.7 to 3.9) and 8.2 (95% CI 6.5 to 10.4) for patients with Charlson Comorbidity Index (CCI) of 1 to 2 and CCI ≥ 3, respectively, compared with patients with CCI of 0. The rate of mortality varied according to geographical region, the lowest being in the East region (1.8%), followed by Beijing (2.1%), the North (2.9%), South-West (3.6%), South-Central (3.8%), North-East (4.1%), and North-West (5.2%) regions.
Conclusion:
While in-hospital mortality after hip arthroplasty in China appears low and declined during the study period, discrepancies in mortality after this procedure exist according to sociodemographic factors. Healthcare resources should be allocated more to underdeveloped regions to further reduce mortality. Cite this article: Bone Joint J 2019;101-B:1209-1217.
