Risk Factors for Perioperative Mortality After Lower Extremity Arthroplasty: A Population-Based Study of 6,901,324 Patient Discharges☆

The goal of this study was to provide nationally representative data on characteristics of patients who died after hip and knee arthroplasty and to determine risk factors for such outcome. Using national in-patient data collected between 1990 and 2004, we identified a cumulative in-hospital mortality rate of 0.35% among an estimated 6 901 324 procedures. The strongest independent risk factors for in-hospital mortality were pulmonary embolism and cerebrovascular complications, which increased the odds for a fatal outcome by approximately 40-fold. Preoperative risk factors for in-hospital mortality were revision total hip arthroplasty, advanced age, and the presence of a number of comorbid diseases, predominantly dementia, renal, and cerebrovascular disease. Our results can be used to identify patients at risk for fatal outcome and implement interventions to reduce such risk.