# The Hidden Risks of Hip Replacement: Unveiling Mortality and Costs in 1.6 Million Patients

## TL;DR

This study analyzed hip replacement outcomes in 1.6 million patients, identifying risk factors for mortality and increased costs.

## Contribution

The study provides a pre-pandemic national baseline for mortality and costs in elective hip replacements.

## Key findings

- Inpatient mortality was 0.04%, but higher in patients over 80, weekend admissions, and delayed surgeries.
- Comorbidities like heart failure and kidney disease significantly increased mortality and costs.
- Acute complications like pulmonary embolism led to higher costs and longer hospital stays.

## Abstract

Methods: Using the most recent pre-COVID National Inpatient Sample (2016–2019), we evaluated inpatient mortality and economic impact after elective primary total hip arthroplasty (THA) across 327,123 cases (1,635,615 weighted discharges).Results: Overall inpatient mortality was 0.04%, but was higher in patients ≥ 80 years (0.15%), with weekend admissions (0.10%), and with surgical delay ≥ 1 day (0.17%). Comorbidities with the greatest mortality association included congestive heart failure and chronic kidney disease (both with markedly elevated odds), and acute in-hospital complications (e.g., pulmonary embolism) carried substantial risk. Complications also increased resource use; for example, heart failure, pulmonary edema, and acute coronary artery disease were each associated with significantly higher costs and prolonged length of stay. Conclusion: These findings provide a contemporary, pre-pandemic national baseline that quantifies high-risk subgroups and the economic footprint of adverse events, supporting targeted perioperative strategies and hospital planning for elective THA.