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:	SaTia T. Sinclair, DO, MPH, Melissa N. Orr, BS, Christopher A. Rothfusz, BS, Alison K. Klika, MS, John P. McLaughlin, DO, Nicolas S. Piuzzi, MD
Formato:	article
Lenguaje:	EN
Publicado:	Elsevier 2021
Materias:	Revision total knee arthroplasty Total knee arthroplasty Mortality Risk assessment Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/ff27fd0d7cdf4e5691bb081c614780ad
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spelling	oai:doaj.org-article:ff27fd0d7cdf4e5691bb081c614780ad2021-11-14T04:34:07ZUnderstanding the 30-day mortality burden after revision total knee arthroplasty2352-344110.1016/j.artd.2021.08.019https://doaj.org/article/ff27fd0d7cdf4e5691bb081c614780ad2021-10-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2352344121001606https://doaj.org/toc/2352-3441Background: 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.SaTia T. Sinclair, DO, MPHMelissa N. Orr, BSChristopher A. Rothfusz, BSAlison K. Klika, MSJohn P. McLaughlin, DONicolas S. Piuzzi, MDElsevierarticleRevision total knee arthroplastyTotal knee arthroplastyMortalityRisk assessmentOrthopedic surgeryRD701-811ENArthroplasty Today, Vol 11, Iss , Pp 205-211 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Revision total knee arthroplasty Total knee arthroplasty Mortality Risk assessment Orthopedic surgery RD701-811
spellingShingle	Revision total knee arthroplasty Total knee arthroplasty Mortality Risk assessment Orthopedic surgery RD701-811 SaTia T. Sinclair, DO, MPH Melissa N. Orr, BS Christopher A. Rothfusz, BS Alison K. Klika, MS John P. McLaughlin, DO Nicolas S. Piuzzi, MD Understanding the 30-day mortality burden after revision total knee arthroplasty
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.
format	article
author	SaTia T. Sinclair, DO, MPH Melissa N. Orr, BS Christopher A. Rothfusz, BS Alison K. Klika, MS John P. McLaughlin, DO Nicolas S. Piuzzi, MD
author_facet	SaTia T. Sinclair, DO, MPH Melissa N. Orr, BS Christopher A. Rothfusz, BS Alison K. Klika, MS John P. McLaughlin, DO Nicolas S. Piuzzi, MD
author_sort	SaTia T. Sinclair, DO, MPH
title	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_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_sort	understanding the 30-day mortality burden after revision total knee arthroplasty
publisher	Elsevier
publishDate	2021
url	https://doaj.org/article/ff27fd0d7cdf4e5691bb081c614780ad
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Understanding the 30-day mortality burden after revision total knee arthroplasty

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