45-day mortality after 467,779 knee replacements for XXXX from the National Joint Registry for England and Wales: an observational study.

@entity1 @entity8 @entity571 @entity66 @entity409 @entity583 @entity204
BACKGROUND: Understanding the risk factors for @entity204 after knee replacement could help to reduce the risk of mortality after this procedure. We assessed secular trends in @entity204 within 45 days of knee replacement for @entity571 in England and Wales, with the aim of investigating whether any change that we recorded could be explained by alterations in modifiable perioperative factors. METHODS: We took data for knee replacements done for @entity571 in England and Wales between April 1, 2003, and Dec 31, 2011, from the National Joint Registry for England and Wales. @entity1 identifiers were used to link these data to the national mortality database and the Hospital Episode Statistics database to obtain details of @entity204 , sociodemographics, and comorbidity. We assessed mortality within 45 days by Kaplan-Meier analysis and assessed the role of @entity1 and treatment factors by Cox proportional hazards models. FINDINGS: 467,779 primary knee replacements were done to treat @entity571 during 9 years. 1183 @entity1 died within 45 days of surgery, with a substantial secular decrease in mortality from 0  37% in 2003 to 0  20% in 2011, even after adjustment for age, sex, and comorbidity. The use of unicompartmental knee replacement was associated with substantially lower mortality than was total knee replacement (hazard ratio [HR] 0  32, 95% CI 0  19   0  54, p<0  0005). Several comorbidities were associated with increased mortality: @entity583 (HR 3  46, 95% CI 2  81   4  14, p<0  0005), @entity66 (3  35, 2  7   4  14, p<0  0005), moderate/severe @entity409 (7  2, 3  93   13  21, p<0  0005), and @entity8 (2  18, 1  76   2  69, p<0  0005). Modifiable perioperative risk factors, including surgical approach and thromboprophylaxis were not associated with mortality. INTERPRETATION: Postoperative mortality after knee replacement has fallen substantially between 2003 and 2011. Efforts to further reduce mortality should concentrate more on older @entity1 , those who are male and those with specific comorbidities, such as @entity583 , @entity66 , @entity409 , and @entity8 . FUNDING: National Joint Registry for England and Wales.
