Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty

C. C. Jørgensen; H. Kehlet; the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group; Kjeld Soeballe; Torben B. Hansen; Henrik Husted; Mogens B. Laursen; Lars T. Hansen; Per Kjærsgaard-Andersen; Soren Solgaard; Niels Harry Krarup

doi:10.1111/aas.12860

Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty

C. C. Jørgensen^*, H. Kehlet, the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Kjeld Soeballe, Torben B. Hansen, Henrik Husted, Mogens B. Laursen, Lars T. Hansen, Per Kjærsgaard-Andersen, Soren Solgaard, Niels Harry Krarup

^*Corresponding author for this work

Department of Clinical Medicine

23 Citations (Scopus)

Abstract

Background: Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. Methods: Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ dysfunction were classified as certain, probable, possible or unlikely. Results: Of a total of 44 deaths (0.3%), 28 (0.2%) were found to have certain or probably relation with surgery and were considered as surgery-related. Surgery-related deaths were more common after THA than TKA (0.3% vs. 0.1% P = 0.044), occurred after median 14 days and 19 of 28 were between day 0–30. Of the remaining 16 deaths (0.1%), nine were found to be possible and seven to be unlikely related to surgery, and occurred a median of 42 and 61 days after surgery. The most common initial organ dysfunction for surgery-related deaths was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. Conclusion: Ninety-days mortality was 0.3% in THA and TKA, but only 28 of 44 deaths (64%) were found to be surgery-related. Reporting total mortality rate or cause of death without considerations on surgery induced organ dysfunction, may be insufficient for future aims to reduce post-operative mortality.

Original language	English
Journal	Acta Anaesthesiologica Scandinavica
Volume	61
Issue number	4
Pages (from-to)	436-444
Number of pages	9
ISSN	0001-5172
DOIs	https://doi.org/10.1111/aas.12860
Publication status	Published - 1 Apr 2017

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Jørgensen, C. C., Kehlet, H., the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Soeballe, K., Hansen, T. B., Husted, H., Laursen, M. B., Hansen, L. T., Kjærsgaard-Andersen, P., Solgaard, S., & Krarup, N. H. (2017). Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty. Acta Anaesthesiologica Scandinavica, 61(4), 436-444. https://doi.org/10.1111/aas.12860

Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty. / Jørgensen, C. C.; Kehlet, H.; the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group et al.

In: Acta Anaesthesiologica Scandinavica, Vol. 61, No. 4, 01.04.2017, p. 436-444.

Research output: Contribution to journal › Journal article › Research › peer-review

Jørgensen, CC, Kehlet, H, the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group, Soeballe, K, Hansen, TB, Husted, H, Laursen, MB, Hansen, LT, Kjærsgaard-Andersen, P, Solgaard, S & Krarup, NH 2017, 'Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty', Acta Anaesthesiologica Scandinavica, vol. 61, no. 4, pp. 436-444. https://doi.org/10.1111/aas.12860

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title = "Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty",

abstract = "Background: Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. Methods: Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ dysfunction were classified as certain, probable, possible or unlikely. Results: Of a total of 44 deaths (0.3%), 28 (0.2%) were found to have certain or probably relation with surgery and were considered as surgery-related. Surgery-related deaths were more common after THA than TKA (0.3% vs. 0.1% P = 0.044), occurred after median 14 days and 19 of 28 were between day 0–30. Of the remaining 16 deaths (0.1%), nine were found to be possible and seven to be unlikely related to surgery, and occurred a median of 42 and 61 days after surgery. The most common initial organ dysfunction for surgery-related deaths was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. Conclusion: Ninety-days mortality was 0.3% in THA and TKA, but only 28 of 44 deaths (64%) were found to be surgery-related. Reporting total mortality rate or cause of death without considerations on surgery induced organ dysfunction, may be insufficient for future aims to reduce post-operative mortality.",

author = "J{\o}rgensen, {C. C.} and H. Kehlet and {the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group} and Kjeld Soeballe and Hansen, {Torben B.} and Henrik Husted and Laursen, {Mogens B.} and Hansen, {Lars T.} and Per Kj{\ae}rsgaard-Andersen and Soren Solgaard and Krarup, {Niels Harry}",

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doi = "10.1111/aas.12860",

language = "English",

volume = "61",

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TY - JOUR

T1 - Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty

AU - Jørgensen, C. C.

AU - Kehlet, H.

AU - the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group

AU - Soeballe, Kjeld

AU - Hansen, Torben B.

AU - Husted, Henrik

AU - Laursen, Mogens B.

AU - Hansen, Lars T.

AU - Kjærsgaard-Andersen, Per

AU - Solgaard, Soren

AU - Krarup, Niels Harry

PY - 2017/4/1

Y1 - 2017/4/1

N2 - Background: Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. Methods: Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ dysfunction were classified as certain, probable, possible or unlikely. Results: Of a total of 44 deaths (0.3%), 28 (0.2%) were found to have certain or probably relation with surgery and were considered as surgery-related. Surgery-related deaths were more common after THA than TKA (0.3% vs. 0.1% P = 0.044), occurred after median 14 days and 19 of 28 were between day 0–30. Of the remaining 16 deaths (0.1%), nine were found to be possible and seven to be unlikely related to surgery, and occurred a median of 42 and 61 days after surgery. The most common initial organ dysfunction for surgery-related deaths was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. Conclusion: Ninety-days mortality was 0.3% in THA and TKA, but only 28 of 44 deaths (64%) were found to be surgery-related. Reporting total mortality rate or cause of death without considerations on surgery induced organ dysfunction, may be insufficient for future aims to reduce post-operative mortality.

AB - Background: Post-operative mortality is an important adverse outcome, including in total hip (THA) and knee arthroplasty (TKA). However, whether mortality is due to anaesthetic/surgical complications, surgically induced organ dysfunction or unrelated to surgery is rarely considered. Methods: Prospective observational study in 13,775 consecutive THA/TKAs with similar fast-track protocols and a median length of stay of 2 days. Complete 90-days follow-up through national registries, followed by review of medical records and death certificates. Relation between mortality and surgically induced organ dysfunction were classified as certain, probable, possible or unlikely. Results: Of a total of 44 deaths (0.3%), 28 (0.2%) were found to have certain or probably relation with surgery and were considered as surgery-related. Surgery-related deaths were more common after THA than TKA (0.3% vs. 0.1% P = 0.044), occurred after median 14 days and 19 of 28 were between day 0–30. Of the remaining 16 deaths (0.1%), nine were found to be possible and seven to be unlikely related to surgery, and occurred a median of 42 and 61 days after surgery. The most common initial organ dysfunction for surgery-related deaths was pulmonary (6/28) and gastrointestinal (6/28), while the most common reported cause of death were pulmonary (9/28) and cardiac events (6/28). In five of the seven unlikely related deaths mortality was attributed to underlying cancer. Conclusion: Ninety-days mortality was 0.3% in THA and TKA, but only 28 of 44 deaths (64%) were found to be surgery-related. Reporting total mortality rate or cause of death without considerations on surgery induced organ dysfunction, may be insufficient for future aims to reduce post-operative mortality.

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U2 - 10.1111/aas.12860

DO - 10.1111/aas.12860

M3 - Journal article

C2 - 28150297

AN - SCOPUS:85011718217

SN - 0001-5172

VL - 61

SP - 436

EP - 444

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

IS - 4

ER -

Time course and reasons for 90-day mortality in fast-track hip and knee arthroplasty

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