Analysis of short- and long-term mortality after hip replacement based on the primary care data

Wahedally, Muhammad (2017) Analysis of short- and long-term mortality after hip replacement based on the primary care data. Doctoral thesis, University of East Anglia.

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The number of primary total hip replacement (THR) procedures is increasing worldwide. An increase in early post-operative mortality is associated with THR while in the long term, advancements in lifestyle factors and surgical techniques for THR suggest an improvement in survival following the procedure. Mortality after primary THR is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. Routinely collected data by general practices can provide useful insights on variations in short and long term mortality after primary THR procedure.

The primary objectives of this research were to investigate how a history of various medical conditions before THR procedures affect the short and long term mortality risk after the surgery for patients in the United Kingdom.

Medical records from 1987 to 2011 from general practices contributing to The Health Improvement Network (THIN) database were used to develop two specific mortality models: to estimate odds ratio of death during the first 24 months after the procedure and to estimate the long term hazard ratio of all-cause mortality following THR. Both mortality models were multilevel and included preoperative comorbidities, lifestyle and socio-demographic factors. These models produced accurate estimates of mortality risk after THR procedures that could inform professional healthcare on future medical management of THR patients and financial planning for retirement by patients, the actuarial industry, and the government.

This research found that in the first 24 months after THR, an excess mortality risk is associated with THR cases compared to controls and preoperative overweight, obesity, smoking, myocardial infarction and male gender increased short term odds of death for all types of THR procedures, compared to controls without these conditions. In the long term, hazard of all-cause mortality for THR cases was lower than controls, and was higher for patients with preoperative hypercholesterolemia, myocardial infarction, osteoarthritis and smoking compared to those without these conditions. However overweight and obese THR cases had better survival prospects than controls and THR cases with normal BMI.

Item Type: Thesis (Doctoral)
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Jennifer Whitaker
Date Deposited: 05 Dec 2018 10:44
Last Modified: 05 Dec 2018 10:44


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