By: 21 June 2017
Increase in digestive disease-related death following joint replacement

A study of nearly 720,000 hip and knee replacement patients has shown that clinicians should be aware of a patient’s potential for post-operative complications relating to the digestive system as well as cardiovascular and respiratory risks.

The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) has carried out an in-depth study to better understand the causes of death following hip and knee replacement. The findings reinforce existing research that highlights complications relating to the heart are the most common cause of death soon after a hip or knee replacement, and one of the most common causes up to 10 years after. However, using the NJR’s dataset, researchers found that there is also a marked increase in digestive disease-related death in the 90 days following hip and knee replacement which needs clinical consideration.

Professor Ashley Blom, from the University of Bristol, who led the team that undertook the study on behalf of the NJR, is calling upon clinicians working in the area of joint replacement to consider the study’s findings to further reduce the risk of death and enhance a patient’s outcome post-operation.

The study, published in April, examined the causes and number of deaths of hip and knee joint replacement patients between 2003 to 2012 compared with those expected from the general population. The research team were able to study 56,568 deaths following 717,025 hip and knee replacement procedures for osteoarthritis over the nine-year period.

Commenting on the reason for the study and its findings, Professor Blom said: “It is important to remember that joint replacement is one of the most highly effective and cost- effective interventions offered to patients with osteoarthritis. The chance of dying following joint replacement remains very low and has halved during the time the NJR has been collecting data, although older patients and males have higher death rates.

“This study has been carried out to better understand what clinical decisions and strategies could be taken to reduce the risk of death even further and enhance a patient’s outcome following joint replacement.

“We expected cardiovascular-related diseases to be the greatest cause of death in the immediate post-operative period following joint replacement surgery. Ischaemic heart disease accounted for around 30 per cent of deaths for both hip and knee replacement patients within 90 days. Further strategies could be introduced to target this and may lead to a reduced risk.

“However, the increased risk of digestive system-related deaths was unexpected. Clinicians need to be aware of this and anticipate problems such as intestinal bleeds, obstructions and perforations. Patients identified with these potential problems or being at risk of them before their operation may require additional preventative strategies and a more rigorous post-operative monitoring and care plan.

“Tackling both cardiovascular and digestive disorders should not only increase life expectancy but enhance the cost-effectiveness of joint replacement.”

Source: National Joint Registry