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Mortality after elective total hip arthroplasty in elderly Americans. Age, gender, and indication for surgery predict
J Whittle1, E P Steinberg, G F Anderson
1Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, Maryland.
Insights
Perioperative mortality for elderly Americans undergoing total hip arthroplasty (THA) is low at 0.95%. Patients had better survival after THA than the general population, with outcomes varying by age and indication.
Area of Science:
- Geriatric Medicine
- Orthopedic Surgery
- Public Health
Background:
- Total hip arthroplasty (THA) is a common procedure for elderly individuals.
- Assessing perioperative mortality and long-term survival is crucial for patient outcomes.
- Previous data often focused on referral centers or specific patient groups.
Purpose of the Study:
- To determine perioperative mortality and cumulative postoperative survival in elderly Americans undergoing THA for non-hip fracture reasons.
- To analyze factors influencing survival, including age, gender, race, and surgical indication.
- To compare survival rates of THA patients with the age-gender-matched general population.
Main Methods:
- Utilized Medicare Part A claims records for elderly Americans undergoing THA.
- Identified surgical indications through diagnosis codes.
- Calculated perioperative mortality and cumulative postoperative survival rates.
- Stratified mortality by age, gender, race, and indication.
Main Results:
- Overall perioperative mortality was 0.95% (48/5078).
- Mortality significantly increased with age, ranging from 0.34% (66-69 years) to 3.75% (≥85 years).
- Mortality was not associated with race, gender, or surgical indication.
- Postoperative survival improved with younger age, female gender, and osteoarthrosis as the indication.
- THA patients demonstrated better survival than the general population.
Conclusions:
- Perioperative mortality for elderly Americans undergoing THA in the community is low.
- Survival rates after THA are favorable compared to the general population.
- Age is a significant factor in perioperative mortality for THA patients.
Abstract:
Medicare Part A claims records were used to determine the perioperative mortality and cumulative postoperative survival of elderly Americans undergoing total hip arthroplasty (THA) for reasons other than hip fracture. The indication for THA was determined by analysis of the diagnosis codes in the claims records. Perioperative mortality was 0.95% (48/5078) and increased with age, from 0.34% (three of 872) in those 66 years to 69 years of age to 3.75% (nine of 240) among those 85 years of age or older. Perioperative mortality was not related to race, gender, or the indication for which the surgery was performed. Among these elderly patients not operated on for hip fracture, cumulative survival after surgery increased with decreasing age, female gender, and when osteoarthrosis was the indication for surgery. Persons undergoing THA had better survival after surgery than the age-gender-matched general population. Perioperative mortality among elderly Americans undergoing THA in the community is low and similar to that estimated by the 1982 NIH Consensus Conference, which considered primarily data reported from referral centers.