Ninety-day mortality after total knee and hip arthroplasties in Hong Kong

Abstract

INTRODUCTION: Total knee (TKA) and hip (THA) arthroplasties are highly successful and cost-effective orthopaedic procedures. Nevertheless, the surgical operation itself poses a risk and may even result in death of the patient. The 90-day mortality rate after TKR and THA was reported to be approximately 0.1-0.8% in the western literature. This study aimed to review the 90-day mortality rate and causes after TKA and THA in public hospitals Hong Kong. MATERIALS AND METHODS: An electronic database in Hospital Authority, Clinical Data Analyses & Reporting System (CDARS), was used to identify patients, who died within ninety days after TKA and THA performed in the period from 2000 to 2011 in public hospitals in Hong Kong, Patients having TKA or THA done because of primary bone malignancies or pathological fractures due to underlying malignancies were excluded from the study. RESULTS: There were total 48 mortalities within 90 days after TKA and THA during the study period (Table 1). The overall 90-day mortality rate of TKA and THA was approximately 0.32% (48 of 15046). For TKA patients, the mortality rate was 0.23% (24 of 10740), in which there were 10 female and 14 male, and the mean age of the patient is 71.6 (range : 57-83). For the THR patients, the mortality rate was 0.55% (24 of 4306), in which there were 13 female and 11 male., and the mean age of the patient is 70.8 (range 40-91). Among the pooled mortality data of both TKA and THA groups, the most common causes of mortalities are cardiovascular complications (14 out of 48, 29.2%), chest infection (6 out of 48, 12.5%), and cerebrovascular accident (4 out of 48, 8.3%). DISCUSSION & CONCLUSIONS: The 90-day mortality rate is comparable to other centres. Cardiovascular complications are the most common causes of early mortality. Vigilant pre-operative cardiovascular assessment and close peri-operative monitoring are necessary after TKA and THA.