Articles90-day mortality after 409 096 total hip replacements for osteoarthritis, from the National Joint Registry for England and Wales: a retrospective analysis
Introduction
Although death as a result of total hip joint replacement is rare, the risk still needs to be quantified and minimised through reduction of risk factors. The UK National Institute for Health and Care Excellence has recommended several measures to reduce postoperative mortality,1 including use of mechanical and chemical thromboprophylaxis. However, obtaining good evidence about the effectiveness of preventive measures is difficult because mortality is low.
The National Joint Registry for England and Wales, established in April, 2003, records all total hip replacements done in England and Wales, the Office for National Statistics records all deaths in England and Wales, and the Hospital Episode Statistics records all inpatient recipients of NHS-funded care in England. Combination of these datasets provides an opportunity to assess many aspects of care in total hip replacement and their association with mortality. Additionally, the effect of patient factors on mortality can be studied.
We analysed postoperative mortality after hip replacement for osteoarthritis with the aims of: estimating the risk of mortality after hip replacement, assessing whether mortality after hip replacement has decreased with time, and identifying which treatment factors are associated with reduced mortality after accounting for patient factors.
Section snippets
Data sources
In this retrospective observational study we analysed data from the National Joint Registry. Details from the National Joint Registry of patients who had had primary total hip replacement were passed to the NHS Personal Demographics Service, which provided dates of death from the Office for National Statistics if the NHS number was traceable. National Joint Registry data were also linked to inpatient and day case records from Hospital Episode Statistics. We produce part 3 of the annual report
Results
Over the 8 years of follow-up available for the whole cohort, the hazard rate increased with time from operation (data not shown), with steeper slopes for men and older age groups, as expected for normal ageing, especially in view of the ages of patients at primary operation (mean 68·4, SD 10·6 years). 1743 patients died in the first 90 days after surgery. The hazard rate within the first 90 days (figure 1) suggests a short-term peak risk of death in the perioperative period that then subsided.
Discussion
We have shown a large fall in early mortality after primary hip joint replacement for osteoarthritis between 2003, and 2011, which was unexpected. If deaths in the earlier period were systematically under-reported, this trend could be an artifact. However, we believe that this scenario is unlikely because most deaths occurred after registration; thus, any under-reporting should have been random and not related to future mortality. Additionally, we report a steady year-on-year fall, rather than
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