Hip Replacements and Mortality

iStock_000055627278_Medium (1)Hip replacement surgery is something that seems likely for many, if not most, as they age. Now comes a study Rick and I discuss on PodMed this week looking at outcomes following said surgery when the procedure was elective versus when it followed a fracture, in JAMA.  Turns out that when matched for everything, including age, gender, multiple co-existing medical conditions, and whether the procedure was scheduled or post-traumatic, those who underwent surgery in the post-traumatic state were six times more likely to die before hospital discharge than those who had elective surgery. That's quite a difference, and one that seems robust given that this study looked at data accumulated from over 300,000 patients over a three year period. Folks who had the surgery secondary to a fracture were also three times more likely to develop complications.

How do we account for this dramatic difference? Rick speculates that some inflammatory condition secondary to trauma might be the culprit, while the authors of the study also speculate that performing surgery as quickly as possible following the fracture might help mitigate some of the pro-inflammatory response.  We all agree that additional research is needed to pinpoint the cause of the increased risk so attempts can be made to minimize it.  Other topics this week include aspirin recommendations for cardiovascular risk reduction and colorectal cancer risk reduction from the USPSTF, long term follow-up of diabetes prevention in the Lancet, and in the same journal risk of death among children of atomic bomb survivors.  Until next week, y'all live well.

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