Arden, NK

Cooper, C

Espallargues, M

Judge, A

Palliso, F

Prieto-Alhambra, D

Tebe, C

Osteoporosis International

Oxford University Research Archive (ORA)

Predictors of post-operative mortality following total hip arthroplasty surgery: a population-based cohort study

Prieto-Alhambra, Daniel

Tebé, C

Pallisó, F

Judge, Andrew

Arden, Nigel

Cooper, Cyrus

ORA - Oxford University Research Archive

Oxford University Research Archive

TITLE: “Predictors of post-operative mortality following total hip arthroplasty surgery: a population-based cohort study.” AUTHORS: A Roso1, C Tebé2, F Pallisó3, A Judge4,5, NK Arden4,5, C Cooper4,5, M Espallargues2, and D Prieto-Alhambra1,4,5, on behalf of the PRESS-UP Group AFFILIATIONS: 1.Idiap Jordi Gol Primary Care Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain 2.Registre Català d’Artroplàsties (RACat), Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Generalitat de Catalunya, Spain 3.Cirurgia Ortopèdica i Traumatologia, Hospital Santa Maria de Lleida, Lleida, Spain 4.MRC Lifecourse Epidemiology Unit, University of Southampton, UK 5.NIHR BRU, NDORMS, University of Oxford, UK  [MAX 2,000 chars] OBJECTIVE/S Data from the UK National Joint Registry have reported on predictors of post-operative mortality following Total Hip Arthroplasty (THA)[1]. We aimed to develop and validate a predictive model for post-THA mortality using data from primary care and hospital records linked to the Catalan Arthroplasty Registry (RACat). METHODS -Setting and participants: RACat collects information on patient, centre, and implant-related variables for patients undergoing THA in Catalonia (Spain). Patients aged ≥40 years undergoing THA in the period 2005-June/2012 in RACat were eligible. Primary care and hospital records together with pharmacy dispensations data were extracted for the linked population from SIDIAP, a large representative database including >80% of the population of Catalonia. Patients in RACat but not present in SIDIAP, and those undergoing THA for hip fracture or malignancy were excluded. -Outcome: 6-month all-cause mortality following THA. -Potential predictors: a list of pre-operative potential risk factors was pre-defined: age, sex, body mass index, smoking, alcohol drinking, Charlson co-morbidity index (CCI), healthcare resource use (number of GP visits), hospital volume (THAs per annum), drugs used in the previous year, and indication. -Analyses: Backwards logistic regression (p exit 0.1) was used to identify key predictors, and the obtained coefficients combined to derive a predictive tool. Area under the ROC curve (AUC-ROC) and Hosmer-Lemeshow test (HL) were used to estimate discrimination and calibration. RESULTS 156/11,427 (1.4%) subjects died in the 6 months post-THA. Key predictors of mortality are detailed in Table 1. A predictive tool based on these variables had good discrimination (AUC ROC 87.3%) [Figure 1], and calibration (HL p=0.83) [Figure 2].   CONCLUSIONS Pre-operative patient characteristics can be used to identify high-risk patients for early post-THA mortality. The proposed tool could be used to improved informed decision making. REFERENCES: 1.Hunt LP et al. Lancet 2013 Sep 28;382(9898):1097-104. ACKNOWLEDGEMENTS: Funded by the Spanish Ministry of Economy and Innovation (FIS Grant ESSARC/PRESS-UP, Exp PI11/01932).   TABLE. Key predictors of 6-month post-THA mortality. Predictor Value Adjusted Odds Ratio [95%CI] Age Per year (older) 1.09 [1.07-1.11] Sex Female 0.66 [0.46-0.95] Alcohol drinking Mild 0.27 [0.12-0.60] BMI Underweight REF  Normal (18.5 to <25) 0.50 [0.33-0.75]  Overweight (25 to <30) 0.33 [0.18-0.59]  Obese (30 and over) 0.42 [0.19-0.96] CCI 0 REF  1 1.97 [1.14-3.42]  2 1.57 [0.95-2.59]  3+ 2.21 [1.41-3.47] Previous non-hip fracture GP diagnosis 0.62 [0.38-1.04] Polyarticular osteoarthritis GP diagnosis 0.66 [0.44-0.99] NSAID use (previous year) Lowest (first quintile) REF  Second quintile 0.52 [0.31-0.85]  Third quintile 0.61 [0.37-0.99]  Fourth quintile 0.38 [0.22-0.68]  Highest (fifth quintile) 0.48 [0.27-0.85] Oral corticosteroids (previous year) ≥3 months of ≥5mg/d prednisolone or equivalent 1.60 [1.00-2.58] Oral anticoagulants (previous year) ≥1 month use 2.39 [1.40-4.09] Tricyclic antidepressants (previous year) ≥1 month use 2.06 [0.91-4.66] Aromatase inhibitor/s (previous year) ≥1 month use 2.49 [0.86-7.20] Calcium/ D supplements (previous year) ≥1 month use 0.55 [0.35-0.87] GP visits previous year 0 REF  4 1.79 [1.15-2.78]  5+ 2.44 [1.56-3.80]  Home visit (≥1) 2.43 [1.67-3.53] Indication for THA (as in RACat registry) Hip osteoarthritis REF  Rheumatoid arthritis 2.86 [1.58-5.18]  Other inflammatory arthritis 3.16 [2.03-4.92] Hospital volume Medium 1.47 [1.05-2.07]    Figure 1. Receiver Operator Characteristics (ROC) plot.  Figure 2. Calibration (expected/observed for each risk decile) plots.  

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Predictors of post-operative mortality following total hip arthroplasty surgery: a population-based cohort study

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