Ke Xu1,2,3, Noel C Chan4,5, Quazi Ibrahim1, Paul Kruger1, Smita Sinha1, Vinai Bhagirath1,5, Jeffrey Ginsberg5, Shrikant Bangdiwala1,5,6, Gordon Guyatt5, John Eikelboom1,5, Jack Hirsh5. 1. Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada. 2. Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China. 3. Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China. 4. Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada. 5. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 6. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Abstract
BACKGROUND: Systematic reviews reporting time trends in mortality following major orthopaedic surgery are few and have limitations. They reported on only a fraction (< 15%) of the available data and did not investigate potential causes of the reduction in mortality. METHODS: We searched PubMed for randomized trials and observational studies, published between 1950 and 2016, reporting on mortality within 3 months of elective total hip and knee replacement (THR/TKR). Mortality risks were estimated for each 5-year interval using a Poisson regression model and presented by study design and mode of prophylaxis. To estimate the mortality reduction unrelated to anti-thrombotic use, we performed a pooled analysis of four thromboprophylaxis strategies for which data spanned five decades. RESULTS: We identified 255 eligible studies, which documented 31,604 deaths among 6,293,954 patients, and found a consistent decline in mortality irrespective of study design and mode of prophylaxis. Mortality declined from 1.15% pre-1980 to 0.24% post-2000, a 78.7% relative risk reduction (95% confidence interval [CI]: 74.7-82.1%) in randomized and cohort studies. Furthermore, our data showed a 74.4% (95% CI: 68.7-79.0%) relative reduction in mortality independent of the methods of prophylaxis, thereby indicating that improvements in peri-operative care unrelated to anti-thrombotic prophylaxis played a major role in such reduction. CONCLUSION: Mortality following elective THR/TKR has markedly declined over the past 50 years and is now low irrespective of which prophylactic agent is being used. Although anti-thrombotic prophylaxis may have contributed, other improvements in peri-operative care played a major role in the mortality reduction. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Systematic reviews reporting time trends in mortality following major orthopaedic surgery are few and have limitations. They reported on only a fraction (< 15%) of the available data and did not investigate potential causes of the reduction in mortality. METHODS: We searched PubMed for randomized trials and observational studies, published between 1950 and 2016, reporting on mortality within 3 months of elective total hip and knee replacement (THR/TKR). Mortality risks were estimated for each 5-year interval using a Poisson regression model and presented by study design and mode of prophylaxis. To estimate the mortality reduction unrelated to anti-thrombotic use, we performed a pooled analysis of four thromboprophylaxis strategies for which data spanned five decades. RESULTS: We identified 255 eligible studies, which documented 31,604 deaths among 6,293,954 patients, and found a consistent decline in mortality irrespective of study design and mode of prophylaxis. Mortality declined from 1.15% pre-1980 to 0.24% post-2000, a 78.7% relative risk reduction (95% confidence interval [CI]: 74.7-82.1%) in randomized and cohort studies. Furthermore, our data showed a 74.4% (95% CI: 68.7-79.0%) relative reduction in mortality independent of the methods of prophylaxis, thereby indicating that improvements in peri-operative care unrelated to anti-thrombotic prophylaxis played a major role in such reduction. CONCLUSION: Mortality following elective THR/TKR has markedly declined over the past 50 years and is now low irrespective of which prophylactic agent is being used. Although anti-thrombotic prophylaxis may have contributed, other improvements in peri-operative care played a major role in the mortality reduction. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Joseph Shalhoub; Rebecca Lawton; Jemma Hudson; Christopher Baker; Andrew Bradbury; Karen Dhillon; Tamara Everington; Manjit S Gohel; Zaed Hamady; Beverley J Hunt; Gerrard Stansby; David Warwick; John Norrie; Alun H Davies Journal: BMJ Date: 2020-05-13
Authors: Daniel C Santana; Ahmed K Emara; Melissa N Orr; Alison K Klika; Carlos A Higuera; Viktor E Krebs; Robert M Molloy; Nicolas S Piuzzi Journal: Medicina (Kaunas) Date: 2020-08-19 Impact factor: 2.430