International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries.
Background and purpose — A challenge comparing outcomes from total hip arthroplasty between countries is variation in preoperative characteristics, particularly comorbidity. Therefore, we investigated between-country variation in comorbidity in patients based on ASA class distribution, and determine...
| Publicado en: | Acta Orthopaedica Vol. 92; no. 3; pp. 304 - 311 |
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| Autores principales: | , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Medical Journals Sweden AB
Jun2021
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=151135946&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 151135946 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 17453674 1BVL jtl: Acta Orthopaedica issn: 17453674 maglogo: N pubinfo: dt: Jun2021 vid: 92 iid: 3 pid: 59195 pub: Medical Journals Sweden AB artinfo: ui: 151135946 149000075 151135946 151135946 10.1080/17453674.2021.1892267 151135946 ppf: 304 ppct: 7 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registries. aug: au: Silman, Alan J Combescure, Christophe Ferguson, Rory J Graves, Stephen E Paxton, Elizabeth W Frampton, Chris Furnes, Ove Fenstad, Anne Marie Hooper, Gary Garland, Anne Spekenbrink-Spooren, Anneke Wilkinson, J Mark Mäkelä, Keijo Lübbeke, Anne Rolfson, Ola affil: Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, UK sug: subj: Arthroplasty, Replacement, Hip Mortality Comorbidity Geographic Factors Registries, Disease Human Survival Analysis Confidence Intervals Descriptive Statistics ab: Background and purpose — A challenge comparing outcomes from total hip arthroplasty between countries is variation in preoperative characteristics, particularly comorbidity. Therefore, we investigated between-country variation in comorbidity in patients based on ASA class distribution, and determined any variation of ASA class to mortality risk between countries. Patients and methods — All arthroplasty registries collecting ASA class and mortality data in patients with elective primary THAs performed 2012–2016 were identified. Survival analyses of the influence of ASA class on 1-year mortality were performed by individual registries, followed by meta-analysis of aggregated data. Results — 6 national registries and 1 US healthcare organization registry with 418,916 THAs were included. There was substantial variation in the proportion of ASA class III/IV, ranging from 14% in the Netherlands to 39% in Finland. Overall, 1-year mortality was 0.93% (95% CI 0.87–1.01) and increased from 0.2% in ASA class I to 8.9% in class IV. The association between ASA class and mortality measured by hazard ratios (HR) was strong in all registries even after adjustment for age and sex, which reduced them by half in all registries. Combined adjusted HRs were 2.0, 6.1, and 22 for ASA class II–IV vs. I, respectively. Associations were moderately heterogeneous across registries. Interpretation — We observed large variation in ASA class distribution between registries, possibly explained by differences in background morbidity and/or international variation in access to surgery. The similar, strong mortality trends by ASA class between countries enhance the relevance of its use as an indicator of comorbidity in international registry studies. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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