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    Perioperative mortality in patients with pulmonary hypertension undergoing major joint replacement

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    Authors
    Memtsoudis, Stavros G.
    Ma, Yan
    Chiu, Ya-Lin
    Walz, J. Matthias
    Voswinckel, Robert
    Mazumdar, Madhu
    UMass Chan Affiliations
    Department of Anesthesiology
    Document Type
    Journal Article
    Publication Date
    2010-11-01
    Keywords
    Adult
    Aged
    Arthroplasty, Replacement, Hip
    Arthroplasty, Replacement, Knee
    Case-Control Studies
    Databases as Topic
    Female
    Hospital Mortality
    Humans
    Hypertension, Pulmonary
    Logistic Models
    Male
    Middle Aged
    Odds Ratio
    Risk Assessment
    Risk Factors
    Time Factors
    Treatment Outcome
    United States
    Anesthesiology
    Orthopedics
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    Link to Full Text
    http://dx.doi.org/10.1213/ANE.0b013e3181f43149
    Abstract
    BACKGROUND: There is a paucity of perioperative outcomes data for patients with chronic pulmonary hypertension (PHTN) undergoing noncardiac surgery. Clinicians, therefore, have little information on which to evaluate the risk for morbidity and mortality in this patient population. In this study, we evaluated the incidence and risks of perioperative morbidity and mortality in patients with PHTN undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: Using the largest inpatient database in the United States (National Inpatient Sample), we identified entries for THA and TKA between the years of 1998 and 2006. Patients with the diagnosis of PHTN were identified and matched to those without the disease based on health-related demographic variables. Perioperative mortality was considered the primary outcome. Multivariate logistic regression models were fitted to assess the impact of PHTN on in-hospital mortality. RESULTS: We identified 670,516 entries for TKA and 360,119 for THA. Of those patients, 2184 (0.3%) and 1359 (0.4%), respectively, had the diagnosis of PHTN (average annual rate of 1180 for TKA [range, 507-2073] and 739 for THA [range, 467-1054]). Patients with PHTN undergoing THA experienced an approximately 4-fold increased adjusted risk of mortality (2.4% vs 0.6%), and those undergoing TKA a 4.5-fold increased adjusted risk of mortality (0.9% vs 0.2%) compared with patients without PHTN in the matched sample (P < 0.001 for each comparison). Patients with primary PHTN undergoing THA experienced the highest mortality rate (5% [95% CI, 2.3%-7.7%]). CONCLUSIONS: This analysis demonstrates that patients with PHTN are at increased risk for perioperative mortality after THA and TKA.
    Source
    Anesth Analg. 2010 Nov;111(5):1110-6. Epub 2010 Sep 14. Link to article on publisher's site
    DOI
    10.1213/ANE.0b013e3181f43149
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/25697
    PubMed ID
    20841415
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1213/ANE.0b013e3181f43149
    Scopus Count
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