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


CONCLUSIONS
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.
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.|The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement, Copenhagen, Denmark.
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Jørgensen
Section for Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.|The Lundbeck Foundation Centre for Fast-track Hip and Knee replacement, Copenhagen, Denmark.
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Kehlet
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality*; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000401:mortality; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012042:Registries