A new study from investigators in Denmark found substantial decreases in mortality rates following elective hip and knee replacement surgeries since 2004 compared with rates for the same arthroplasty surgeries performed between 1989 and 1991.
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As reported in Arthritis & Rheumatology, researchers note that the lower mortality rates are partly tied to more modern surgical techniques and improvement of peri- and postoperative care, despite surgeries on older patients having multiple comorbidities.1 Researcher and co-author Arief Lalmohamed, PharmD, of Utrecht University in The Netherlands, says the decreased mortality rates should be comforting to patients and rheumatologists alike.
“We don’t think that most people assumed survival hasn’t improved over the past 20 years,” Lalmohamed tells The Rheumatologist. “Because of the advances over the years, a decline in mortality was expected, although we were never sure of it. … [T]hese results are reassuring.”
The retrospective cohort study looked at 71,812 total hip replacement (THR) and 40,642 total knee replacement (TKR) patients over two time periods. Compared with surgeries conducted between 1989 and 1991, 60-day mortality rates were substantially lower for THR patients (95% CI 0.28–0.58) and TKR patients (95% CI 0.21–0.67) whose surgeries were performed between 2004 and 2007. Decreased mortality rates were greatest for deaths from myocardial infarction, venous thromboembolism, pneumonia and stroke. In addition, hospital length of stay was roughly halved between the two time frames.
Future research will likely continue to show reductions in mortality rates among THR and TKR patients for surgeries performed since 2007, Lalmohamed states. “Improved postoperative care, increased use of multimodal anesthesia, advanced techniques [and] optimized rehabilitation programs are possible explanations for this ongoing decline,” he adds.
Lalmohamed says the data, while validated in Denmark, are likely similar in the United Kingdom and the United States. What impact rheumatologists have on mortality rates depends on their role at their respective institutions.“The contribution of rheumatologists depends on which part of postoperative care they normally are involved [in],” he adds. “They may be involved in rehabilitation programs, which have been demonstrated to improve patient outcomes after surgery. In some countries, they are also involved in surgical decisions … or optimization of preoperative drug use, which could have further improved survival.” (posted 5/8/2014)
Richard Quinn is a freelance writer in New Jersey.
1. Lalmohamed A, Vestergaard P, de Boer A, et al: Changes in mortality patterns following total hip or knee arthroplasty over the past two decades: A nationwide cohort study. Arthritis Rheumatol. 2014 Feb;66(2):311–318.