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Understanding the 30-day mortality burden after revision total knee arthroplasty

BACKGROUND: In revision total knee arthroplasty (TKA), information regarding perioperative mortality risk is essential for careful decision-making. This study aimed to elucidate the (1) overall 30-day mortality rate and (2) 30-day mortality rate stratified by age, comorbidity, and septic vs aseptic...

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Autores principales: Sinclair, SaTia T., Orr, Melissa N., Rothfusz, Christopher A., Klika, Alison K., McLaughlin, John P., Piuzzi, Nicolas S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502837/
https://www.ncbi.nlm.nih.gov/pubmed/34660865
http://dx.doi.org/10.1016/j.artd.2021.08.019
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author Sinclair, SaTia T.
Orr, Melissa N.
Rothfusz, Christopher A.
Klika, Alison K.
McLaughlin, John P.
Piuzzi, Nicolas S.
author_facet Sinclair, SaTia T.
Orr, Melissa N.
Rothfusz, Christopher A.
Klika, Alison K.
McLaughlin, John P.
Piuzzi, Nicolas S.
author_sort Sinclair, SaTia T.
collection PubMed
description BACKGROUND: In revision total knee arthroplasty (TKA), information regarding perioperative mortality risk is essential for careful decision-making. This study aimed to elucidate the (1) overall 30-day mortality rate and (2) 30-day mortality rate stratified by age, comorbidity, and septic vs aseptic failure after revision TKA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was reviewed for all patients undergoing revision TKA from 2011 to 2019. A total of 32,354 patients who underwent TKA were identified and categorized as mortality (n = 115) or mortality-free (n = 32,239). Patient characteristics were compared between cohorts and further stratified by septic and aseptic failure. RESULTS: The overall 30-day mortality rate was 0.36%. The percentage of deaths per age group (normalized per 1000) was 0% (18-29 years), 0% (30-39 years), 0.18% (40-49 years), 0.13% (50-59 years), 0.14% (60-69 years), 0.40% (70-79 years), 1.25% (80-89 years), and 6.93% (90+ years). The percentage of deaths per American Society of Anesthesiologists (ASA) class was 0.30% (ASA 1), 0.06% (ASA 2), 0.39% (ASA 3), 2.41% (ASA 4), and 14.29% (ASA 5). Septic revision (P < .001), general anesthesia (P < .001), body mass index ≤ 24.9 (P < .001), and insulin-dependent diabetes (P = .039) were associated with an increased risk of mortality. CONCLUSIONS: Increasing age, greater comorbidity burden, underweight or normal body mass index, insulin-dependent diabetes, septic revision, and general anesthesia were all associated with an increased risk of mortality after revision TKA. Notably, 1 in 80 patients aged 80-89 years died after revision TKA compared to 1 in 720 patients aged 60-69 years. Patients who underwent septic revision had a 4-fold increase in mortality compared to aseptic revision. Our stratified assessment of mortality provides a more individualized estimation of risk that can be used for patient counseling in revision TKA.
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spelling pubmed-85028372021-10-15 Understanding the 30-day mortality burden after revision total knee arthroplasty Sinclair, SaTia T. Orr, Melissa N. Rothfusz, Christopher A. Klika, Alison K. McLaughlin, John P. Piuzzi, Nicolas S. Arthroplast Today Original Research BACKGROUND: In revision total knee arthroplasty (TKA), information regarding perioperative mortality risk is essential for careful decision-making. This study aimed to elucidate the (1) overall 30-day mortality rate and (2) 30-day mortality rate stratified by age, comorbidity, and septic vs aseptic failure after revision TKA. METHODS: The American College of Surgeons National Surgical Quality Improvement Program was reviewed for all patients undergoing revision TKA from 2011 to 2019. A total of 32,354 patients who underwent TKA were identified and categorized as mortality (n = 115) or mortality-free (n = 32,239). Patient characteristics were compared between cohorts and further stratified by septic and aseptic failure. RESULTS: The overall 30-day mortality rate was 0.36%. The percentage of deaths per age group (normalized per 1000) was 0% (18-29 years), 0% (30-39 years), 0.18% (40-49 years), 0.13% (50-59 years), 0.14% (60-69 years), 0.40% (70-79 years), 1.25% (80-89 years), and 6.93% (90+ years). The percentage of deaths per American Society of Anesthesiologists (ASA) class was 0.30% (ASA 1), 0.06% (ASA 2), 0.39% (ASA 3), 2.41% (ASA 4), and 14.29% (ASA 5). Septic revision (P < .001), general anesthesia (P < .001), body mass index ≤ 24.9 (P < .001), and insulin-dependent diabetes (P = .039) were associated with an increased risk of mortality. CONCLUSIONS: Increasing age, greater comorbidity burden, underweight or normal body mass index, insulin-dependent diabetes, septic revision, and general anesthesia were all associated with an increased risk of mortality after revision TKA. Notably, 1 in 80 patients aged 80-89 years died after revision TKA compared to 1 in 720 patients aged 60-69 years. Patients who underwent septic revision had a 4-fold increase in mortality compared to aseptic revision. Our stratified assessment of mortality provides a more individualized estimation of risk that can be used for patient counseling in revision TKA. Elsevier 2021-10-04 /pmc/articles/PMC8502837/ /pubmed/34660865 http://dx.doi.org/10.1016/j.artd.2021.08.019 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Sinclair, SaTia T.
Orr, Melissa N.
Rothfusz, Christopher A.
Klika, Alison K.
McLaughlin, John P.
Piuzzi, Nicolas S.
Understanding the 30-day mortality burden after revision total knee arthroplasty
title Understanding the 30-day mortality burden after revision total knee arthroplasty
title_full Understanding the 30-day mortality burden after revision total knee arthroplasty
title_fullStr Understanding the 30-day mortality burden after revision total knee arthroplasty
title_full_unstemmed Understanding the 30-day mortality burden after revision total knee arthroplasty
title_short Understanding the 30-day mortality burden after revision total knee arthroplasty
title_sort understanding the 30-day mortality burden after revision total knee arthroplasty
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8502837/
https://www.ncbi.nlm.nih.gov/pubmed/34660865
http://dx.doi.org/10.1016/j.artd.2021.08.019
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