Mortality and fatal pulmonary embolism after primary total hip replacement: Results from a regional hip register

Abstract

We calculated the rates for perioperative mortality and fatal pulmonary embolism (PE) after primary total hip replacement in a single UK health region, using a regional arthroplasty register and the tracing service of the Office of National Statistics. During 1990, there were 2111 consecutive primary replacements in 2090 separate procedures. Within 42 days of operation a total of 19 patients had died (0.91%, 95% CI 0.55 to 1.42). Postmortem examination showed that four deaths (0.19%, 95% CI 0.05 to 0.49) were definitely due to PE. The overall perioperative mortality and fatal PE rates are low and in our study did not appear to be altered by the use of chemical thromboprophylaxis (perioperative mortality rate: one-tailed Fisher's exact test, p = 0.39; fatal PE rate: one-tailed Fisher's exact test, p = 0.56). The routine use of chemical thromboprophylaxis for primary THR is still controversial. The issue should be addressed by an appropriate randomised, prospective study using overall mortality and fatal PE rate as the main outcome measures, but the feasibility of such a study is questioned.

Aspirin: An Alternative for Pulmonary Embolism Prophylaxis After Arthroplasty?

“…Although the morbidity and mortality associated with PE has been markedly reduced in recent years, the risk still remains clinically important [14,39]. In the 9 th edition of the ACCP guidelines, for the first time, aspirin was recognized as an effective method of thromboprophylaxis for low-to standard-risk patients undergoing TJA (Grade IB) [13].…”

Potent Anticoagulants are Associated with a Higher All-Cause Mortality Rate After Hip and Knee Arthroplasty

“…During the last decade, in patient populations ranging from 1947 to 130,000, the reported incidence of fatal PE has decreased substantially to a rate of 0% to 0.2% [16,21,39]. This is a result of advancements in anesthesia, surgical technique, perioperative care and our better understanding of the pathogenesis of thromboembolic disease during and after surgery [11,24,25,56].…”

Status of Healthcare

“…VTE includes deep vein thrombosis (DVT) and pulmonary embolism (PE), which are the most serious complications of DVT. The PE mortality rate within the first few weeks following THA is between 0.09 % and 0.19 % (Fender et al 1997;Howie et al 2005;Khan et al 2007;Shepherd and Mills 2006).…”