Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement
UMass Chan Affiliations
Department of AnesthesiologyDocument Type
Journal ArticlePublication Date
2010-11-01Keywords
AdultAged
Arthroplasty, Replacement, Hip
Arthroplasty, Replacement, Knee
Case-Control Studies
Databases as Topic
Female
Hospital Mortality
Humans
Hypertension, Pulmonary
Logistic Models
Male
Middle Aged
Odds Ratio
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Anesthesiology
Orthopedics
Metadata
Show full item recordAbstract
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.Source
Anesth Analg. 2010 Nov;111(5):1110-6. Epub 2010 Sep 14. Link to article on publisher's siteDOI
10.1213/ANE.0b013e3181f43149Permanent Link to this Item
http://hdl.handle.net/20.500.14038/25697PubMed ID
20841415Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1213/ANE.0b013e3181f43149