Understanding the 30-day mortality burden after revision total knee arthroplasty

Abstract

Background: In revision total knee arthroplasty (TKA), information regarding perioperative mortality risk is essential for careful decision-making. This study aimed to elucidate the (1) overall 30-day mortality rate and (2) 30-day mortality rate stratified by age, comorbidity, and septic vs aseptic failure after revision TKA. Methods: The American College of Surgeons National Surgical Quality Improvement Program was reviewed for all patients undergoing revision TKA from 2011 to 2019. A total of 32,354 patients who underwent TKA were identified and categorized as mortality (n ¼ 115) or mortality-free (n ¼ 32,239). Patient characteristics were compared between cohorts and further stratified by septic and aseptic failure. Results: The overall 30-day mortality rate was 0.36%. The percentage of deaths per age group (normalized per 1000) was 0% (18-29 years), 0% (30-39 years), 0.18% (40-49 years), 0.13% (50-59 years), 0.14% (60-69 years), 0.40% (70-79 years), 1.25% (80-89 years), and 6.93% (90þ years). The percentage of deaths per American Society of Anesthesiologists (ASA) class was 0.30% (ASA 1), 0.06% (ASA 2), 0.39% (ASA 3), 2.41% (ASA 4), and 14.29% (ASA 5). Septic revision (P < .001), general anesthesia (P < .001), body mass index 24.9 (P < .001), and insulin-dependent diabetes (P ¼ .039) were associated with an increased risk of mortality. Conclusions: Increasing age, greater comorbidity burden, underweight or normal body mass index, insulin-dependent diabetes, septic revision, and general anesthesia were all associated with an increased risk of mortality after revision TKA. Notably, 1 in 80 patients aged 80-89 years died after revision TKA compared to 1 in 720 patients aged 60-69 years. Patients who underwent septic revision had a 4-fold increase in mortality compared to aseptic revision. Our stratified assessment of mortality provides a more individualized estimation of risk that can be used for patient counseling in revision TKA.

Thirty-Day Mortality and Complication Rates in Total Joint Arthroplasty After a Recent COVID-19 Diagnosis

“…Another study showed similar rates for primary THAs (0.29%) and revision THAs (0.30%) 26 . The mortality rates of primary TKAs (0.098%) and revision TKAs (0.36%) were similar 27,28 .…”

The Impact of Hepatitis C on Complication Rates After Revision Total Knee Arthroplasty: A Matched Cohort Study

“…Therefore, these results may not be applicable to patients with a high perioperative mortality risk. This limitation is notable given that the mortality risk after an rTKA is not insignificant, especially for patients undergoing a septic rTKA and those with a greater comorbidity burden, both of which are more common in patients with HCV [ 27 , 32 , 33 ]. Additionally, the possibility of coding errors is inherent with any analysis of administrative claims data.…”

Decreasing trend of inpatient mortality rates of aseptic versus septic revision total hip arthroplasty: an analysis of 681,034 cases

“…5,7 Despite mortality being the most feared and devastating outcome associated with rTHA, there is a paucity of literature characterising inpatient mortality rates associated with the procedure especially when compared to studies in total knee arthroplasty. 27,28 Furthermore, there is limited data quantifying changing trends in mortality rate when looking at septic and aseptic indications for revision surgery. Our study found an overall inpatient mortality rate of 0.91% when all indications for revision surgery were considered.…”