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KCE Reports 113 Volume Outcome 173
Table 7.8: Total hip arthroplasty: In-hospital outcomes (index stay)
Number
total
number
outcome
%
outcome
Death 11856 28 0.24
Deep venous thrombosis 11856 12 0.10
Pulmonary embolism 11856 12 0.10
Deep wound infection 11856 7 0.06
7.1.5.2 Complications within 90 days
The 90 days interval starts with the total hip replacement index admission. This period
of time was chosen previously by Katz. et al. to maximise the likelihood of causality
between the hip replacement and the adverse event as effect of the procedure. 311
Information on the 90-day complication rate is retrieved from two sources:
1. the index admission: on the basis of the secondary diagnosis;
2. consecutive readmissions that occurred within 90 days from index admission:
on the basis of the principal diagnosis or procedure.
The following ICD-9-CM diagnosis (as primary or secondary diagnosis) or procedure
codes are used:
• Pulmonary embolism: 415.1 “Pulmonary embolism and infarction as
principal diagnosis”
• Deep venous thrombosis (DVT): 451.1x “Phlebitis and thrombophlebitis
of deep vessels of lower extremities”
• Deep wound infection: 996.66 “Infection and inflammatory reaction due
to internal joint prosthesis”
• Mechanical complication: 996.4 “Mechanical complication of internal
orthopaedic device, implant, & graft”
• Other complications: at least one ICD-9-CM diagnosis code indicating
“Other complications of internal prosthetic device, implant, & graft”:
o 996.77 “Due to internal joint prosthesis”
o or 996.78 “Due to other internal orthopaedic device, implant, &
graft”
o or 996.79 “Due to other internal prosthetic device, implant, &
graft”
• Dislocation of hip within 90 days from initial admission: at least one of the
following codes:
o diagnosis 835.x “Dislocation of hip”
o or procedure 79.75 “Closed reduction of dislocation of hip”
o or procedure 79.85 “Open reduction of dislocation of hip”.
As shown in Table 7.9, the most frequent complication observed during hospitalization
(initial or readmissions) within 90 days after admission was a mechanical complication of
the prosthesis with 1.96% 95%CI (1.72%, 2.22%), followed by 1.69% of hip dislocation
95%CI (1.46%, 1.94%). There is a certain overlap between categories. For example,
some patients who were readmitted in a hospital with a principal diagnosis 996.4
“Mechanical complication” also underwent a reduction of hip dislocation (ICD-9-CM
procedure 79.75 or 79.85). Some patients also experienced different complications or
were readmitted more than once. Therefore, a global outcome category was created to
group all patients who encountered any of the above complications within 90 days after
the initial hip arthroplasty admission. Table 7.9 shows that 3.33% 95%CI (3.02% 3.67%)
of the patients (number = 395) had at least one of the studied post-operative
complications within 90 days after the first THR.