Mortality Rates after Hip, Knee Surgery Fall

Arief Lalmohamed, PharmD Utrecht Area, Netherlands Interview with:

Arief Lalmohamed, PharmD
Utrecht Area, Netherlands What are the main findings of the study?

Dr. Lalmohamed: In a nationwide cohort study, short-term survival following elective
hip and knee replacement surgery has greatly improved since the early
90s. Between 1989 and 2007, risk of death within 60 days has decreased
by 60% for hip surgery and 63% for knee surgery. This translates into
a 60-day mortality rate of 0.23% between 2003 and 2007. Were any of the findings unexpected?

Dr. Lalmohamed: The findings were somewhat unexpected when taking into account the
following observation: surgical patients tended to have more
co-morbidity over time (e.g. diabetes, COPD, and heart failure). Even
when not adjusting for this trend, the drop in mortality rates
remained present. This suggests that, despite surgical patients having
a more complex risk profile, this did not result into a higher rate of
short-term mortality. What should clinicians and patients take away from your report?

Dr. Lalmohamed: For patients who are about to undergo elective hip or knee replacement surgery, the observed decline in mortality rates is reassuring. For
clinicians, this might imply that changes in patient care, surgical
techniques, and the introduction of novel therapeutics may indeed have
improved short-term survival. As an example, we found a relationship
between the length of hospital stay and mortality, which supports
current common practice of mobilizing these surgical patients as fast
as possible. What recommendations do you have for future research as a result of this study?

Dr. Lalmohamed: Although this study showed that mortality rates were low on an overall
level, there may still be patients who are at substantially increased
risk of death (or non-fatal complications) following elective hip or
knee replacement surgery. We therefore promote the development of
clinical risk scores that can estimate the risk of these unwanted
outcomes in each individual patient who is thinking about undergoing
such an elective procedure.


Changes in mortality patterns following total hip or knee replacement over
the past two decades: A nationwide cohort study

Lalmohamed A, Vestergaard P, de Boer A, Leufkens HG, van Staa TP, de Vries F.
Arthritis Rheum. 2013 Dec 18. doi: 10.1002/art.38232. [Epub ahead of print]


Last Updated on December 21, 2014 by Marie Benz MD FAAD