Early death following primary total hip arthroplasty: 1,727 procedures with mechanical thrombo-prophylaxis

Background The aims of this study were to quantify the risk and identify the causes of early postoperative mortality after total hip arthroplasty. This would help clinicians address preventable causes of death and help in accurate counseling and consenting of patients.

Methods We determined the death rate at 90 days in an unselected consecutive series of 1,727 primary total hip arthroplasties where patients had not routinely received chemothromboprophylaxis.

Results The mortality at 90 days was 17/1,727 (1%). The 90-day mortality was 0.2% in patients under 70 years of age, 1.3% in patients between 70 and 80, and 2.5% in those over 80. 7 patients died from ischemic heart disease, 4 died following cerebrovascular events, and 2 from pulmonary embolism. 4 patients died from non-vascular causes. Of the vascular deaths, ischemic heart disease outnumbered cerebrovascular events which, in turn, outnumbered pulmonary embolism (7 vs. 4 vs. 2).

Interpretation Strategies aimed at reducing deaths should address all vascular causes, not just pulmonary embolism. Our findings can be used to inform patients as to the risk of early death after total hip arthroplasty.