title: Morbidity and Mortality in Elective Total Hip Arthroplasty Following Surgical Care Improvement Project Guidelines.
abstract: Following evidence questioning the safety and efficacy of perioperative beta-blocker therapy in noncardiac surgery, the Surgical Care Improvement Project (SCIP) guidelines were retired in 2015. However, perioperative myocardial infarctions and cardiac complications remain leading causes of mortality following noncardiac surgery. The impact of the SCIP guidelines on reducing cardiac complications in patients undergoing elective total hip arthroplasty (THA) has not been evaluated.
  
  
  
  The Nationwide Inpatient Sample was queried for 345,875 elective THA performed from 2003 to 2011. Patient demographics and morbidity as well as the incidence of nonfatal and fatal cardiac complications and overall mortality associated with cardiac complications were determined before and following SCIP implementation.
  
  
  
  Following the institution of the SCIP guidelines, the overall mortality following cardiac complications decreased by 41%. Although the incidence of nonfatal cardiac events after THA did increase 5% (primarily secondary to an increased incidence of nonfatal hypotension), the incidence of postoperative inpatient mortality, stroke, fatal hypotension, fatal myocardial infarction, and nonfatal and fatal cardiac arrest significantly decreased.
  
  
  
  Following the implementation of SCIP guidelines, there was a 41% reduction in mortality and a significant decrease in fatal cardiac complications, postoperative hypotension, myocardial infarction, and cardiac arrest. Despite SCIP guidelines being retired in 2015, evidence supports continuation of perioperative beta-blockade in primary elective total adult hip and knee arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Bemenderfer
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina; Dickson Advanced Analysis Group (DA(2)), Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Nigel L
authors.initials: NL
authors.lastname: Rozario
authors.affiliation: Dickson Advanced Analysis Group (DA(2)), Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Madhav A
authors.initials: MA
authors.lastname: Karunakar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000401:mortality*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D058996:Quality Improvement; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: arthroplasty; cardiac; complications; elective; hip; surgical care improvement project