{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T20:08:23Z","timestamp":1790885303237,"version":"4.1.0"},"reference-count":36,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T00:00:00Z","timestamp":1628035200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study aimed to analyze the rates and risk factors of postoperative mortality among 560,954 patients who underwent total knee arthroplasty (TKA) in Korea. The National Health Insurance Service-Health Screening database was used to analyze 560,954 patients who underwent TKA between 2005 and 2018. In-hospital, ninety-day, and one-year postoperative mortality, and their association with patient\u2019s demographic factors and various comorbidities (ie., cerebrovascular disease, congestive heart failure, and myocardial infarction) were assessed. In-hospital, ninety-day and one-year mortality rates after TKA were similar from 2005 to 2018. The risk of in-hospital mortality increased with comorbidities like cerebrovascular disease (hazard ratio [HR]\u2009=\u20091.401; 95% confidence interval [CI]\u2009=\u20091.064\u20131.844), congestive heart failure (HR\u2009=\u20092.004; 95% CI\u2009=\u20091.394 to 2.881), myocardial infarction (HR\u2009=\u20092.111; 95% CI\u2009=\u20091.115 to 3.998), and renal disease (HR\u2009=\u20092.641; 95% CI\u2009=\u20091.348\u20135.173). These co-morbidities were also independent predictors of ninety-day and one-year mortality. Male sex and old age were independent predictors for ninety-day and one-year mortality. And malignancy was risk factor for one-year mortality. The common preoperative risk factors for mortality in all periods were male sex, old age, cerebrovascular disease, congestive heart failure, myocardial infarction, and renal disease. Malignancy was identified as risk factor for one-year mortality. Patients with these comorbidities should be provided better perioperative care.<\/jats:p>","DOI":"10.1038\/s41598-021-95346-3","type":"journal-article","created":{"date-parts":[[2021,8,4]],"date-time":"2021-08-04T10:04:26Z","timestamp":1628071466000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Incidence and risk factors analysis for mortality after total knee arthroplasty based on a large national database in Korea"],"prefix":"10.1038","volume":"11","author":[{"given":"Ho-Jun","family":"Choi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Kook","family":"Yoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyun-Cheol","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju-Hyung","family":"Yoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong-Hyuk","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Ho","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Hoon","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,4]]},"reference":[{"issue":"17","key":"95346_CR1","doi-asserted-by":"publisher","first-page":"1349","DOI":"10.1001\/jama.1994.03510410061034","volume":"271","author":"CM Callahan","year":"1994","unstructured":"Callahan, C. M. et al. Patient outcomes following tricompartmental total knee replacement. A meta-analysis. Jama 271(17), 1349\u20131357 (1994).","journal-title":"Jama"},{"key":"95346_CR2","doi-asserted-by":"publisher","first-page":"963","DOI":"10.2106\/00004623-200405000-00012","volume":"5","author":"O Ethgen","year":"2004","unstructured":"Ethgen, O. et al. Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J. Bone Joint Surg. Am. 5, 963\u201374 (2004).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"8","key":"95346_CR3","first-page":"1719","volume":"87","author":"RL Kane","year":"2005","unstructured":"Kane, R. L. et al. The functional outcomes of total knee arthroplasty. J. Bone Joint Surg. Am. 87(8), 1719\u20131724 (2005).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"1","key":"95346_CR4","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1080\/17453670610013501","volume":"78","author":"P R\u00e4s\u00e4nen","year":"2007","unstructured":"R\u00e4s\u00e4nen, P. et al. Effectiveness of hip or knee replacement surgery in terms of quality-adjusted life years and costs. Acta Orthop. 78(1), 108\u2013115 (2007).","journal-title":"Acta Orthop."},{"issue":"8","key":"95346_CR5","doi-asserted-by":"publisher","first-page":"635","DOI":"10.7326\/0003-4819-133-8-200010170-00016","volume":"133","author":"DT Felson","year":"2000","unstructured":"Felson, D. T. et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann. Intern. Med. 133(8), 635\u201346 (2000).","journal-title":"Ann. Intern. Med."},{"issue":"2","key":"95346_CR6","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1002\/art.40692","volume":"71","author":"D Misra","year":"2019","unstructured":"Misra, D. et al. Risk of Knee osteoarthritis with obesity, Sarcopenic Obesity, and Sarcopenia. Arthritis Rheumatol. 71(2), 232\u2013237 (2019).","journal-title":"Arthritis Rheumatol."},{"issue":"17","key":"95346_CR7","doi-asserted-by":"publisher","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","volume":"100","author":"M Sloan","year":"2018","unstructured":"Sloan, M., Premkumar, A. & Sheth, N. P. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J. Bone Joint Surg. Am. 100(17), 1455\u20131460 (2018).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"17","key":"95346_CR8","doi-asserted-by":"publisher","first-page":"1386","DOI":"10.2106\/JBJS.N.01141","volume":"97","author":"H Maradit Kremers","year":"2015","unstructured":"Maradit Kremers, H. et al. Prevalence of total Hip and Knee replacement in the United States. J. Bone Joint Surg. Am. 97(17), 1386\u20131397 (2015).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"4","key":"95346_CR9","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1002\/art.23525","volume":"59","author":"S Kim","year":"2008","unstructured":"Kim, S. Changes in surgical loads and economic burden of hip and knee replacements in the US: 1997\u20132004. Arthritis Rheum 59(4), 481\u2013488 (2008).","journal-title":"Arthritis Rheum"},{"issue":"4","key":"95346_CR10","doi-asserted-by":"publisher","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","volume":"89","author":"S Kurtz","year":"2007","unstructured":"Kurtz, S. et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J. Bone Joint Surg. Am. 89(4), 780\u2013785 (2007).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"3","key":"95346_CR11","doi-asserted-by":"publisher","first-page":"660","DOI":"10.2106\/00004623-200603000-00027","volume":"88","author":"WE Garrett Jr","year":"2006","unstructured":"Garrett, W. E. Jr. et al. American board of orthopaedic surgery practice of the orthopaedic surgeon: part-II, certification examination case mix. J. Bone Joint Surg. Am. 88(3), 660\u2013667 (2006).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"5","key":"95346_CR12","doi-asserted-by":"publisher","first-page":"1441","DOI":"10.1007\/s11999-012-2622-y","volume":"471","author":"IJ Koh","year":"2013","unstructured":"Koh, I. J. et al. Trends in use of total knee arthroplasty in Korea from 2001 to 2010. Clin. Orthop. Relat. Res. 471(5), 1441\u20131450 (2013).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"12","key":"95346_CR13","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.2106\/JBJS.17.00249","volume":"100","author":"JR Berstock","year":"2018","unstructured":"Berstock, J. R. et al. Mortality after total Knee arthroplasty: a systematic review of incidence, temporal trends, and risk factors. J. Bone Joint Surg. Am. 100(12), 1064\u20131070 (2018).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"7","key":"95346_CR14","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.3899\/jrheum.110280","volume":"38","author":"JA Singh","year":"2011","unstructured":"Singh, J. A. et al. Early postoperative mortality following joint arthroplasty: a systematic review. J. Rheumatol. 38(7), 1507\u20131513 (2011).","journal-title":"J. Rheumatol."},{"issue":"3","key":"95346_CR15","doi-asserted-by":"publisher","first-page":"288","DOI":"10.1080\/17453674.2017.1279496","volume":"88","author":"EN Glassou","year":"2017","unstructured":"Glassou, E. N., Pedersen, A. B. & Hansen, T. B. Is decreasing mortality in total hip and knee arthroplasty patients dependent on patients\u2019 comorbidity?. Acta Orthop. 88(3), 288\u2013293 (2017).","journal-title":"Acta Orthop."},{"issue":"3","key":"95346_CR16","doi-asserted-by":"publisher","first-page":"201","DOI":"10.2106\/JBJS.J.01958","volume":"94","author":"E Losina","year":"2012","unstructured":"Losina, E. et al. The dramatic increase in total knee replacement utilization rates in the United States cannot be fully explained by growth in population size and the obesity epidemic. J. Bone Joint Surg. Am. 94(3), 201\u2013207 (2012).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"12","key":"95346_CR17","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1007\/s00264-011-1235-5","volume":"35","author":"SM Kurtz","year":"2011","unstructured":"Kurtz, S. M. et al. International survey of primary and revision total knee replacement. Int. Orthop. 35(12), 1783\u20131789 (2011).","journal-title":"Int. Orthop."},{"issue":"12","key":"95346_CR18","doi-asserted-by":"publisher","first-page":"3928","DOI":"10.1002\/art.21420","volume":"52","author":"NB Jain","year":"2005","unstructured":"Jain, N. B. et al. Trends in epidemiology of knee arthroplasty in the United States, 1990\u20132000. Arthritis Rheum. 52(12), 3928\u20133933 (2005).","journal-title":"Arthritis Rheum."},{"issue":"1","key":"95346_CR19","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.surge.2013.12.004","volume":"13","author":"EJ Smith","year":"2015","unstructured":"Smith, E. J., Maru, M. & Siegmeth, A. Thirty-day mortality after elective hip and knee arthroplasty. Surgeon 13(1), 5\u20138 (2015).","journal-title":"Surgeon"},{"issue":"1","key":"95346_CR20","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.arth.2008.11.010","volume":"25","author":"SG Memtsoudis","year":"2010","unstructured":"Memtsoudis, S. G. et al. Risk factors for perioperative mortality after lower extremity arthroplasty: a population-based study of 6,901,324 patient discharges. J. Arthroplasty 25(1), 19\u201326 (2010).","journal-title":"J. Arthroplasty"},{"issue":"6 Suppl","key":"95346_CR21","doi-asserted-by":"publisher","first-page":"349s","DOI":"10.1378\/chest.124.6_suppl.349S","volume":"124","author":"FA Anderson Jr","year":"2003","unstructured":"Anderson, F. A. Jr. et al. Temporal trends in prevention of venous thromboembolism following primary total hip or knee arthroplasty 1996\u20132001: findings from the Hip and Knee Registry. Chest 124(6 Suppl), 349s\u2013356s (2003).","journal-title":"Chest"},{"issue":"2","key":"95346_CR22","first-page":"242","volume":"80","author":"NE Sharrock","year":"1995","unstructured":"Sharrock, N. E. et al. Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth. Analg. 80(2), 242\u2013248 (1995).","journal-title":"Anesth. Analg."},{"issue":"9952","key":"95346_CR23","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.1016\/S0140-6736(14)60540-7","volume":"384","author":"LP Hunt","year":"2014","unstructured":"Hunt, L. P. et al. 45-day mortality after 467,779 knee replacements for osteoarthritis from the National Joint Registry for England and Wales: an observational study. Lancet 384(9952), 1429\u20131436 (2014).","journal-title":"Lancet"},{"issue":"10","key":"95346_CR24","doi-asserted-by":"publisher","first-page":"948","DOI":"10.2106\/JBJS.J.00425","volume":"93","author":"MC Parry","year":"2011","unstructured":"Parry, M. C., Smith, A. J. & Blom, A. W. Early death following primary total knee arthroplasty. J. Bone Joint Surg. Am. 93(10), 948\u2013953 (2011).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"1","key":"95346_CR25","doi-asserted-by":"publisher","first-page":"20","DOI":"10.2106\/JBJS.M.00018","volume":"96","author":"PJ Belmont Jr","year":"2014","unstructured":"Belmont, P. J. Jr. et al. Thirty-day postoperative complications and mortality following total knee arthroplasty: incidence and risk factors among a national sample of 15,321 patients. J. Bone Joint Surg. Am. 96(1), 20\u201326 (2014).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"8","key":"95346_CR26","doi-asserted-by":"publisher","first-page":"1417","DOI":"10.1016\/j.arth.2012.03.008","volume":"27","author":"JA Singh","year":"2012","unstructured":"Singh, J. A. & Lewallen, D. G. Ninety-day mortality in patients undergoing elective total hip or total knee arthroplasty. J. Arthroplasty 27(8), 1417-1422.e1 (2012).","journal-title":"J. Arthroplasty"},{"issue":"8","key":"95346_CR27","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.2106\/00004623-200108000-00004","volume":"83","author":"J Parvizi","year":"2001","unstructured":"Parvizi, J. et al. Thirty-day mortality after total knee arthroplasty. J. Bone Joint Surg. Am. 83(8), 1157\u20131161 (2001).","journal-title":"J. Bone Joint Surg. Am."},{"issue":"6","key":"95346_CR28","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1007\/s11999.0000000000000256","volume":"476","author":"P J\u00e4ms\u00e4","year":"2018","unstructured":"J\u00e4ms\u00e4, P. et al. Moderate to severe renal insufficiency is associated with high mortality after Hip and Knee Replacement. Clin. Orthop. Relat. Res. 476(6), 1284\u20131292 (2018).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"11","key":"95346_CR29","doi-asserted-by":"publisher","first-page":"2437","DOI":"10.1016\/j.arth.2016.04.031","volume":"31","author":"OF Erkocak","year":"2016","unstructured":"Erkocak, O. F. et al. Incidence of infection and inhospital mortality in patients with chronic renal failure after total joint arthroplasty. J. Arthroplasty 31(11), 2437\u20132441 (2016).","journal-title":"J. Arthroplasty"},{"issue":"7","key":"95346_CR30","doi-asserted-by":"publisher","first-page":"e613","DOI":"10.3928\/01477447-20140626-51","volume":"37","author":"BF Deegan","year":"2014","unstructured":"Deegan, B. F. et al. Impact of chronic kidney disease stage on lower-extremity arthroplasty. Orthopedics 37(7), e613\u2013e618 (2014).","journal-title":"Orthopedics"},{"issue":"1","key":"95346_CR31","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s43019-020-0029-8","volume":"32","author":"CW Kim","year":"2020","unstructured":"Kim, C. W. et al. Effect of chronic kidney disease on outcomes of total joint arthroplasty: a meta-analysis. Knee Surg. Relat. Res. 32(1), 12 (2020).","journal-title":"Knee Surg. Relat. Res."},{"issue":"59","key":"95346_CR32","doi-asserted-by":"publisher","first-page":"100288","DOI":"10.18632\/oncotarget.22215","volume":"8","author":"LT Kuo","year":"2017","unstructured":"Kuo, L. T. et al. Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study. Oncotarget 8(59), 100288\u2013100295 (2017).","journal-title":"Oncotarget"},{"issue":"1","key":"95346_CR33","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3109\/17453674.2013.878829","volume":"85","author":"A Miric","year":"2014","unstructured":"Miric, A., Inacio, M. C. & Namba, R. S. Can total knee arthroplasty be safely performed in patients with chronic renal disease?. Acta Orthop. 85(1), 71\u201378 (2014).","journal-title":"Acta Orthop."},{"issue":"1","key":"95346_CR34","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1007\/s11999-011-2043-3","volume":"470","author":"KJ Bozic","year":"2012","unstructured":"Bozic, K. J. et al. Patient-related risk factors for postoperative mortality and periprosthetic joint infection in medicare patients undergoing TKA. Clin. Orthop. Relat. Res. 470(1), 130\u2013137 (2012).","journal-title":"Clin. Orthop. Relat. Res."},{"issue":"5","key":"95346_CR35","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","volume":"40","author":"ME Charlson","year":"1987","unstructured":"Charlson, M. E. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J. Chronic Dis. 40(5), 373\u2013383 (1987).","journal-title":"J. Chronic Dis."},{"issue":"11","key":"95346_CR36","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","volume":"43","author":"H Quan","year":"2005","unstructured":"Quan, H. et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med. Care 43(11), 1130\u20131139 (2005).","journal-title":"Med. Care"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-95346-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-95346-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-95346-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T12:02:17Z","timestamp":1670068937000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-95346-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,4]]},"references-count":36,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["95346"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-95346-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,4]]},"assertion":[{"value":"16 October 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"15772"}}