The Hidden Risks of Hip Replacement: Unveiling Mortality and Costs in 1.6 Million Patients

Using the most recent pre-COVID National Inpatient Sample (2016-2019), we evaluated inpatient mortality and economic impact after elective primary total hip arthroplasty (THA) across 327,123 cases (1,635,615 weighted discharges).

Overall inpatient mortality was 0.04%, but was higher in patients ≥ 80 years (0.15%), with weekend admissions (0.10%), and with surgical delay ≥ 1 day (0.17%). Comorbidities with the greatest mortality association included congestive heart failure and chronic kidney disease (both with markedly elevated odds), and acute in-hospital complications (e.g., pulmonary embolism) carried substantial risk. Complications also increased resource use; for example, heart failure, pulmonary edema, and acute coronary artery disease were each associated with significantly higher costs and prolonged length of stay.

These findings provide a contemporary, pre-pandemic national baseline that quantifies high-risk subgroups and the economic footprint of adverse events, supporting targeted perioperative strategies and hospital planning for elective THA.