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Outcomes/Effectiveness Research

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Total, partial, and revision hip replacement are associated with different rates of postoperative complications and readmissions

About 200,000 total hip replacements, 100,000 partial hip replacements, and 36,000 revision hip replacements were performed in the United States in 2003, according to a new study by researchers at the Agency for Healthcare Quality and Research, and the Food and Drug Administration. About 60 percent of the patients were 65 years or age or older and at least three-fourths had one or more coexisting diseases.

Both total hip replacement, which is usually planned surgery for osteoarthritis, and revision hip replacement, typically performed to treat complications of earlier hip replacements, appear to be safe. The risk of adverse patient outcomes, especially following partial hip replacement, is mostly due to advanced age, coexisting diseases, and emergency admissions (usually for hip fracture).

Researchers screened more than 8 million hospital discharge abstracts from the 2003 Healthcare Cost and Utilization Project Nationwide Inpatient Sample and about 9 million discharge abstracts from 5 State inpatient databases. They found that hip replacement procedures varied in in-hospital mortality rates, at 0.33 percent for total hip replacements, 3.04 percent for partial hip replacements, and 0.84 percent for revision hip replacements.

The perioperative complication rates associated with the three procedures were 0.68 percent, 1.36 percent, and 1.08 percent, respectively, for deep vein thrombosis or pulmonary embolism; 0.28 percent, 1.88 percent, and 1.27 percent for pressure sores; and 0.05 percent, 0.06 percent, and 0.25 percent for postoperative infection.

Rates of hospital readmission for any cause within 30 days were 4.91 percent, 12.15 percent, and 8.48 percent, respectively. Rates of readmissions within 30 days that resulted in a surgical procedure on the affected hip were 0.79 percent, 0.91 percent, and 1.53 percent. Advanced age and coexisting diseases were associated with worse outcomes, while private insurance coverage and planned admissions were associated with better outcomes.

More details are in "Incidence and short-term outcomes of primary and revision hip replacement in the United States," by Chunliu Zhan, M.D., Ph.D., Ronald Kaczmarek, M.D., M.P.H., Nilsa Loyo-Berrios, Ph.D., Judith Sangl, Ph.D., and Rosalie A. Bright, Sc.D., in the March 2007 Journal of Bone & Joint Surgery 89, pp. 526-533.

Reprints (AHRQ Publication No. 07-R053) are available from the AHRQ Publications Clearinghouse.

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