Abstract
Aims
Our main aim was to describe the trend in the comorbidities of patients undergoing elective THRs and KRs between 2005 and 2018 in England.
Patients and Methods
We combined data from the National Joint Registry (NJR) on primary elective hip and knee replacements performed between 2005-2018 with pre-existing conditions recorded at the time of their primary operation from Hospital Episodes Statistics. We described the temporal trend in the number of comorbidities identified using the Charlson comorbidity index, and how this varied by age, gender, ASA grade, index of multiple deprivation and type of KR.
Results
We included 696,504 and 833,745 elective primary THRs and KRs respectively, performed for any indication. Between 2005 and 2018 the proportion of elective THR and KR patients with ≥1 comorbidities at the time of their operation increased substantially (THR: 20% to 38%, KR: 22% to 41%). This was driven by increases in four conditions: COPD (2018: 16-17%), diabetes without complications (2018: THR 10%, KR 14%), myocardial infarction (2018: 4%), and renal disease (2018: 7-8%). Notably, renal disease prevalence increased from <1% in 2005 to 7-8% in 2018.
Conclusion
Between 2005 and 2018 there were significant changes in the number of comorbidities recorded in patients having elective primary THRs and KRs. Renal disease is now one of the most prevalent comorbidities in this patient population. Future research should explore whether this comorbidity trend has increased the burden on other medical specialities to optimise these patients before surgery and to provide additional aftercare.
Our main aim was to describe the trend in the comorbidities of patients undergoing elective THRs and KRs between 2005 and 2018 in England.
Patients and Methods
We combined data from the National Joint Registry (NJR) on primary elective hip and knee replacements performed between 2005-2018 with pre-existing conditions recorded at the time of their primary operation from Hospital Episodes Statistics. We described the temporal trend in the number of comorbidities identified using the Charlson comorbidity index, and how this varied by age, gender, ASA grade, index of multiple deprivation and type of KR.
Results
We included 696,504 and 833,745 elective primary THRs and KRs respectively, performed for any indication. Between 2005 and 2018 the proportion of elective THR and KR patients with ≥1 comorbidities at the time of their operation increased substantially (THR: 20% to 38%, KR: 22% to 41%). This was driven by increases in four conditions: COPD (2018: 16-17%), diabetes without complications (2018: THR 10%, KR 14%), myocardial infarction (2018: 4%), and renal disease (2018: 7-8%). Notably, renal disease prevalence increased from <1% in 2005 to 7-8% in 2018.
Conclusion
Between 2005 and 2018 there were significant changes in the number of comorbidities recorded in patients having elective primary THRs and KRs. Renal disease is now one of the most prevalent comorbidities in this patient population. Future research should explore whether this comorbidity trend has increased the burden on other medical specialities to optimise these patients before surgery and to provide additional aftercare.
| Original language | English |
|---|---|
| Pages (from-to) | 1052-1059 |
| Number of pages | 8 |
| Journal | Bone and Joint Journal |
| Volume | 104-B |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - 1 Sept 2022 |
Keywords
- Total hip replacement
- knee replacement
- comorbidity
- cohort study
Access to Document
- Full-text PDF (author accepted manuscript)
This is the accepted author manuscript (AAM). The final published version (version of record) is available online via British Editorial Society of Bone and Joint Surgery at https://doi.org/10.1302/0301-620X.104B9.BJJ-2022-0013.R1. Please refer to any applicable terms of use of the publisher.