Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty - A register-based cohort study

Abstract

Objective: To investigate the implications of low and moderate preoperative alcohol consumption on postoperative mortality and morbidity after primary hip and knee arthroplasty.

Methods: A total of 30,799 patients who underwent primary hip or knee arthroplasty between January 1st, 2005 and October 8th, 2011 with information on preoperative alcohol consumption (0 grams of pure alcohol/week, >0-168 g/week, >168-252 g/week, and >252 g/week) were identified through the Danish Anesthesia Database. The 90-day and 1-year risks of mortality (primary outcomes), 1-year risk of prosthetic infection, and 30-day risks of cardiovascular disease and deep venous thrombosis (secondary outcomes) were estimated by Cox regression analysis.

Results: We identified 285 (0.9%) deaths within the first 90 days and 694 (2.3%) within the first year. Within the first 30 days, 209 (0.7%) and 270 (0.9%) patients had acquired cardiovascular disease and deep venous thrombosis, respectively, and 514 (1.7%) patients developed prosthetic infection within the first year. The adjusted mortality models yielded hazard ratios of 0.55 (95% confidence interval [CI] 0.41 to 0.74) at 90 days and 0.61 (95% CI 0.51 to 0.73) at 1 year for the group consuming >0-168 g/week when compared to abstainers. Adjusted hazard ratios showed that the group consuming >0-168 g/week had a 0.91 (95% CI 0.75 to 1.11) risk of prosthetic infection, 0.68 (95% CI 0.50 to 0.92) risk of cardiovascular disease and 0.88 (95% CI 0.67 to 1.15) risk of deep venous thrombosis when compared to abstainers.

Conclusions: This study demonstrates that low-to-moderate alcohol consumption prior to primary hip or knee arthroplasty is associated with lower risks of mortality at both 90 days and 1 year after surgery and of cardiovascular disease after 30 days. More research from longitudinal studies is needed to identify specific causal relations and explanations.

Fig 1. 1-year survival rates after primary hip or knee arthroplasty plotted by the Kaplan Meier survival function.

The survival rates of 30,799 patients, according to different levels of preoperative alcohol consumption during the first postoperative year after primary hip or knee arthroplasty in Denmark.

Fig 2. Postoperative mortality at 90 days and 1 year.

Unadjusted and adjusted 90-day and 1-year risks of mortality among 30,799 arthroplasty patients with different preoperative levels of alcohol consumption.

Fig 3. Risk of postoperative morbidity.

Unadjusted and adjusted risks of prosthetic infection after 1 year and cardiovascular disease and deep venous thrombosis after 30 days among 30,799 arthroplasty patients with different preoperative levels of alcohol consumption.