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...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Medical Journals Sweden
2021-05-01
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| Series: | Acta Orthopaedica |
| Online Access: | http://dx.doi.org/10.1080/17453674.2021.1892267 |
| _version_ | 1818319611972550656 |
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| author | Alan J Silman Christophe Combescure Rory J Ferguson Stephen E Graves Elizabeth W Paxton Chris Frampton Ove Furnes Anne Marie Fenstad Gary Hooper Anne Garland Anneke Spekenbrink-Spooren J Mark Wilkinson Keijo Mäkelä Anne Lübbeke Ola Rolfson |
| author_facet | Alan J Silman Christophe Combescure Rory J Ferguson Stephen E Graves Elizabeth W Paxton Chris Frampton Ove Furnes Anne Marie Fenstad Gary Hooper Anne Garland Anneke Spekenbrink-Spooren J Mark Wilkinson Keijo Mäkelä Anne Lübbeke Ola Rolfson |
| author_sort | Alan J Silman |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-13T10:11:52Z |
| format | Article |
| id | doaj.art-7d54d5af1b564d11be5c6f704bf24f71 |
| institution | Directory Open Access Journal |
| issn | 1745-3674 1745-3682 |
| language | English |
| last_indexed | 2024-12-13T10:11:52Z |
| publishDate | 2021-05-01 |
| publisher | Medical Journals Sweden |
| record_format | Article |
| series | Acta Orthopaedica |
| spelling | doaj.art-7d54d5af1b564d11be5c6f704bf24f712022-12-21T23:51:25ZengMedical Journals SwedenActa Orthopaedica1745-36741745-36822021-05-0192330431010.1080/17453674.2021.18922671892267International variation in distribution of ASA class in patients undergoing total hip arthroplasty and its influence on mortality: data from an international consortium of arthroplasty registriesAlan J Silman0Christophe Combescure1Rory J Ferguson2Stephen E Graves3Elizabeth W Paxton4Chris Frampton5Ove Furnes6Anne Marie Fenstad7Gary Hooper8Anne Garland9Anneke Spekenbrink-Spooren10J Mark Wilkinson11Keijo Mäkelä12Anne Lübbeke13Ola Rolfson14Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of OxfordDivision of Clinical Epidemiology, Geneva University HospitalsNuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of OxfordAustralian Orthopaedic Association National Joint Replacement RegistrySurgical Outcomes and Analysis, Kaiser PermanenteDepartment of Medicine, University of OtagoThe Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University HospitalThe Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University HospitalOrthopaedic Surgery and Musculoskeletal Medicine, University of OtagoDepartment of Orthopaedics, Visby lasarett Institute of Surgical Scienses, Uppsala UniversitetDutch Arthroplasty Register, ’s-HertogenboschDepartment of Oncology and Metabolism, University of SheffieldDepartment of Orthopaedics and Traumatology, Turku University Hospital and University of TurkuNuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of OxfordDepartment of Orthopaedics, Institute of Clinical Sciences Sahlgrenska Academy, University of GothenburgBackground 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.http://dx.doi.org/10.1080/17453674.2021.1892267 |
| spellingShingle | Alan J Silman Christophe Combescure Rory J Ferguson Stephen E Graves Elizabeth W Paxton Chris Frampton Ove Furnes Anne Marie Fenstad Gary Hooper Anne Garland Anneke Spekenbrink-Spooren J Mark Wilkinson Keijo Mäkelä Anne Lübbeke Ola Rolfson 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 Acta Orthopaedica |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | http://dx.doi.org/10.1080/17453674.2021.1892267 |
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