title: Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement.
abstract: BACKGROUND
  There is a paucity of perioperative outcomes data for patients with chronic pulmonary hypertension (PHTN) undergoing noncardiac surgery. Clinicians, therefore, have little information on which to evaluate the risk for morbidity and mortality in this patient population. In this study, we evaluated the incidence and risks of perioperative morbidity and mortality in patients with PHTN undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA).
  
  
  METHODS
  Using the largest inpatient database in the United States (National Inpatient Sample), we identified entries for THA and TKA between the years of 1998 and 2006. Patients with the diagnosis of PHTN were identified and matched to those without the disease based on health-related demographic variables. Perioperative mortality was considered the primary outcome. Multivariate logistic regression models were fitted to assess the impact of PHTN on in-hospital mortality.
  
  
  RESULTS
  We identified 670,516 entries for TKA and 360,119 for THA. Of those patients, 2184 (0.3%) and 1359 (0.4%), respectively, had the diagnosis of PHTN (average annual rate of 1180 for TKA [range, 507-2073] and 739 for THA [range, 467-1054]). Patients with PHTN undergoing THA experienced an approximately 4-fold increased adjusted risk of mortality (2.4% vs 0.6%), and those undergoing TKA a 4.5-fold increased adjusted risk of mortality (0.9% vs 0.2%) compared with patients without PHTN in the matched sample (P < 0.001 for each comparison). Patients with primary PHTN undergoing THA experienced the highest mortality rate (5% [95% CI, 2.3%-7.7%]).
  
  
  CONCLUSIONS
  This analysis demonstrates that patients with PHTN are at increased risk for perioperative mortality after THA and TKA.
authors.affiliation: Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA. memtsoudiss@hss.edu
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Memtsoudis
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Ya Lin
authors.initials: YL
authors.lastname: Chiu
authors.forename: J Matthias
authors.initials: JM
authors.lastname: Walz
authors.forename: Robert
authors.initials: R
authors.lastname: Voswinckel
authors.forename: Madhu
authors.initials: M
authors.lastname: Mazumdar
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality*; D016022:Case-Control Studies; D019992:Databases as Topic; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology