{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T06:44:16Z","timestamp":1790664256070,"version":"4.1.0"},"reference-count":0,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>\n            Background\u2003Systematic reviews reporting time trends in mortality following major orthopaedic surgery are few and have limitations. They reported on only a fraction (&lt; 15%) of the available data and did not investigate potential causes of the reduction in mortality.<\/jats:p><jats:p>\n            Methods\u2003We searched PubMed for randomized trials and observational studies, published between 1950 and 2016, reporting on mortality within 3 months of elective total hip and knee replacement (THR\/TKR). Mortality risks were estimated for each 5-year interval using a Poisson regression model and presented by study design and mode of prophylaxis. To estimate the mortality reduction unrelated to anti-thrombotic use, we performed a pooled analysis of four thromboprophylaxis strategies for which data spanned five decades.<\/jats:p><jats:p>\n            Results\u2003We identified 255 eligible studies, which documented 31,604 deaths among 6,293,954 patients, and found a consistent decline in mortality irrespective of study design and mode of prophylaxis. Mortality declined from 1.15% pre-1980 to 0.24% post-2000, a 78.7% relative risk reduction (95% confidence interval [CI]: 74.7\u201382.1%) in randomized and cohort studies. Furthermore, our data showed a 74.4% (95% CI: 68.7\u201379.0%) relative reduction in mortality independent of the methods of prophylaxis, thereby indicating that improvements in peri-operative care unrelated to anti-thrombotic prophylaxis played a major role in such reduction.<\/jats:p><jats:p>\n            Conclusion\u2003Mortality following elective THR\/TKR has markedly declined over the past 50 years and is now low irrespective of which prophylactic agent is being used. Although anti-thrombotic prophylaxis may have contributed, other improvements in peri-operative care played a major role in the mortality reduction.<\/jats:p>","DOI":"10.1055\/s-0039-1677732","type":"journal-article","created":{"date-parts":[[2019,1,31]],"date-time":"2019-01-31T00:12:06Z","timestamp":1548893526000},"page":"668-674","source":"Crossref","is-referenced-by-count":27,"title":["Reduction in Mortality following Elective Major Hip and Knee Surgery: A Systematic Review and Meta-Analysis"],"prefix":"10.1055","volume":"119","author":[{"given":"Ke","family":"Xu","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China"},{"name":"Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noel","family":"Chan","sequence":"additional","affiliation":[{"name":"Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quazi","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Kruger","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Smita","family":"Sinha","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinai","family":"Bhagirath","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Ginsberg","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shrikant","family":"Bangdiwala","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Guyatt","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Eikelboom","sequence":"additional","affiliation":[{"name":"Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada"},{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Hirsh","sequence":"additional","affiliation":[{"name":"Department of Medicine, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,1,30]]},"container-title":["Thrombosis and Haemostasis"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0039-1677732.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T21:23:51Z","timestamp":1557177831000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0039-1677732"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,30]]},"references-count":0,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2019,3,18]]},"published-print":{"date-parts":[[2019,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0039-1677732","relation":{},"ISSN":["0340-6245","2567-689X"],"issn-type":[{"value":"0340-6245","type":"print"},{"value":"2567-689X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,1,30]]}}}