Background:Revision total hip arthroplasty (THA) is a challenging procedure that burdens the healthcare system. Despite being associated with worse outcomes relative to its primary counterpart, postoperative mortality after revision THA remains ill-defined. The present study aimed to (1) establish the overall 30-day mortality rate after revision THA and (2) explore the mortality rate stratified by age, comorbidity burden, and aseptic versus septic failure.Methods:The American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent revision THA from 2011 to 2019. A total of 23,501 patients were identified and grouped into mortality (n = 161) and mortality-free (n = 23,340) cohorts. Patient demographics, comorbidities, and aseptic/septic failure were evaluated.Results:The overall 30-day mortality was 0.69%. The mortality rate by age group (normalised per 1000 patients) was 0 (18–39 years [Y]), 0.67 (40–49 Y), 1.10 (50–59 Y), 2.58 (60–69 Y), 6.15 (70–79 Y) 19.32 (80–89 Y), and 58.22 (90+Y) (p < 0.001). The mortality rate by ASA classification (normalised per 1000 patients) was 0 (ASA I), 1.47 (ASA II), 6.94 (ASA III), 45.42 (ASA IV), and 200 (ASA V) (p < 0.001). The 30-day mortality rate for the septic and aseptic cohorts was 1.03% and 0.65%, respectively (p = 0.038). CCI scores (p < 0.001), diabetes (p < 0.001), systematic sepsis (p < 0.001), poor functional status (p < 0.001), BMI < 24.9 kg/m² (p < 0.001), and dirty/infected wounds (p < 0.001) were all associated with increased mortality risk.Conclusions:1 in 145 patients will suffer mortality during the 30 days after revision THA. PJI-related revision THA was associated with 1.5-fold increase in 30-day mortality rate compared to its aseptic counterpart. Certain patient determinants and baseline comorbidities, as measured by ASA and CCI scores, were associated with higher 30-day mortality rates. Therefore, it is imperative to identify such risk factors and implement perioperative patient optimisation pathways to mitigate the risk among vulnerable patients.

中文翻译：

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了解翻修全髋关节置换术后 30 天的死亡率负担


背景：翻修性全髋关节置换术（THA）是一项具有挑战性的手术，给医疗保健系统带来了负担。尽管与初次手术相比，结果较差，但翻修全髋关节置换后的术后死亡率仍然不明确。本研究旨在 (1) 确定 THA 翻修后 30 天的总体死亡率，以及 (2) 探讨按年龄、合并症负担以及无菌性与脓毒性失败分层的死亡率。 方法：美国外科医生学会 – 国家外科质量改进计划 (ACS-NSQIP) 数据库对 2011 年至 2019 年接受翻修 THA 的所有患者进行了回顾性审查。总共确定了 23,501 名患者，并将其分为死亡 ( n = 161) 和无死亡 ( n = 23,340) 队列。对患者人口统计学、合并症和无菌/脓毒症失败进行了评估。结果：30 天总体死亡率为 0.69%。按年龄组划分的死亡率（标准化为每 1000 名患者）为 0（18-39 岁 [Y]）、0.67（40-49 岁）、1.10（50-59 岁）、2.58（60-69 岁）、6.15（ 70–79 Y) 19.32 (80–89 Y) 和 58.22 (90+Y) ( p < 0.001)。 ASA 分类的死亡率（每 1000 名患者标准化）为 0 (ASA I)、1.47 (ASA II)、6.94 (ASA III)、45.42 (ASA IV) 和 200 (ASA V) ( p < 0.001)。脓毒症组和无菌组的 30 天死亡率分别为 1.03% 和 0.65% ( p = 0.038)。 CCI 评分 ( p < 0.001)、糖尿病 ( p < 0.001)、系统性败血症 ( p < 0.001)、功能状态差 ( p < 0.001)、BMI < 24。9 kg/m ² ( p < 0.001) 和脏/感染伤口 ( p < 0.001) 均与死亡风险增加相关。结论：145 名患者中的 1 名将在翻修 THA 后 30 天内死亡。与无菌手术相比，PJI 相关的 THA 翻修术与 30 天死亡率增加 1.5 倍相关。通过 ASA 和 CCI 评分衡量的某些患者决定因素和基线合并症与较高的 30 天死亡率相关。因此，必须识别此类风险因素并实施围手术期患者优化途径，以减轻弱势患者的风险。