title: Early postoperative mortality following joint arthroplasty: a systematic review.
abstract: OBJECTIVE
  To perform a systematic review of 30- and 90-day mortality rates in patients undergoing hip or knee arthroplasties.
  
  
  METHODS
  Five databases were searched for English-language studies of mortality in hip or knee arthroplasties and the following data were extracted: patient characteristics (age, sex, ethnicity), arthroplasty characteristics (unilateral vs bilateral, hip vs knee), system factors (hospital volume and surgeon volume), year of study, etc. Mortality rates were compared across variable categories; proportions were compared using relative risk ratios and 95% confidence intervals.
  
  
  RESULTS
  Out of 650 titles and abstracts, 80 studies qualified for analysis. Of these, 35%, 34%, and 31% of studies provided 30-, 90-, and > 90-day mortality rates. Overall 30-day mortality rates across all types of arthroplasties were 0.3%; 90-day, 0.7%. For those reports with specific rates, 30-day mortality was significantly higher in men than women [1.8% vs 0.4%, respectively; relative risk (RR) 3.93, 95% CI 3.30-4.68] and in bilateral versus unilateral procedures (0.5% vs 0.3%; RR 1.6, 95% CI 1.49-1.72), but no differences were noted by the underlying diagnosis of osteoarthritis (OA) versus rheumatoid arthritis (0.4% vs 0.3%; RR 0.77, 95% CI 0.48-1.24). 90-day mortality showed nonsignificant trends favoring women, OA as the underlying diagnosis, and unilateral procedures.
  
  
  CONCLUSIONS
  Several demographic and surgical factors were associated with higher 30-day mortality rates following knee and hip arthroplasties. More studies are needed to examine the effect of body mass index, comorbidities, and other modifiable factors, in order to identify interventions to lower mortality rates following arthroplasty procedures.
authors: Medicine Service and Center for Surgical Medical Acute Care Research and Transitions, Birmingham Veterans Affairs (VA) Medical Center, Birmingham, Alabama, USA. Jasvinder.md@gmail.com
authors: Jasvinder A
authors: JA
authors: Singh
authors: Joseph
authors: J
authors: Kundukulam
authors: Daniel L
authors: DL
authors: Riddle
authors: Vibeke
authors: V
authors: Strand
authors: Peter
authors: P
authors: Tugwell
mesh_terms: D001172:Arthritis, Rheumatoid / Q000601:surgery; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D015207:Osteoarthritis, Hip / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000601:surgery; D011184:Postoperative Period; D015996:Survival Rate; D013997:Time Factors