Key result
Higher ASA class was strongly associated with increased 1-year mortality after total hip arthroplasty, with adjusted hazard ratios of 2.0, 6.1, and 22 for ASA classes II, III, and IV versus class I.
Why the study?
Comparing total hip arthroplasty outcomes between countries is challenged by variation in preoperative comorbidity, prompting investigation of between-country variation in ASA class distribution and its relationship to mortality risk.
Does higher ASA class predict 1-year mortality in patients undergoing elective primary total hip arthroplasty?
Population
418,916 elective primary THAs across 6 national registries and 1 US healthcare organization registry
Comparison
ASA classes II-IV vs ASA class I
Design
Registry-based survival analyses and meta-analysis of aggregated data
Follow-up
1-year
Authors
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Supports ASA-based risk stratification before THA; hypothesis-generating for targeted interventions in higher classes.
Meta-Analysis (n=418,916)
Yes
Does higher ASA class predict 1-year mortality in patients undergoing elective primary total hip arthroplasty?
Effect estimate: HR 2.0, 6.1, and 22
Absolute Event Rate: 8.9% vs 0.2%
ASA class is a strong, consistent predictor of 1-year mortality across international arthroplasty registries, supporting its use as a comorbidity indicator.
Silman et al. (2021) conducted a meta-analysis in Elective primary total hip arthroplasty (n=418,916). Higher ASA class (II-IV) vs. ASA class I was evaluated on 1-year mortality (HR 2.0, 6.1, and 22). Higher ASA class was strongly associated with increased 1-year mortality after total hip arthroplasty, with adjusted hazard ratios of 2.0, 6.1, and 22 for ASA classes II, III, and IV versus class I.