Evidence map›Paper›PMID 29997141›Full record

SynthesisBMJ open2018

Impact of comorbid conditions on outcomes of hip and knee replacement surgery: a systematic review and meta-analysis.

Bélène Podmore, Andrew Hutchings, Jan van der Meulen, Ajay Aggarwal, Sujith Konan

Abstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
55citing papers in PubMed, 3 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

55 citing papers in PubMed, 3 syntheses or guidelines pooled it.

  1. Pooled it
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  5. Pre-operative methicillin-resistantJournal of shoulder and elbow arthroplasty · 2026
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  20. Risk of Postoperative Complications After Total Hip and Total Knee Arthroplasty in Behcet Syndrome Patients.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Bélène PodmoreDepartment of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.ORCID 0000-0001-6627-0378
Andrew HutchingsDepartment of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Jan van der MeulenDepartment of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Ajay AggarwalDepartment of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK.
Sujith KonanOrthopaedics and Trauma, University College London Hospitals NHS Foundation Trust, London, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo systematically perform a meta-analysis of the association between different comorbid conditions on safety (short-term outcomes) and effectiveness (long-term outcomes) in patients undergoing hip and knee replacement surgery.

designSystematic review and meta-analysis.

methodsMedline, Embase and CINAHL Plus were searched up to May 2017. We included all studies that reported data to allow the calculation of a pooled OR for the impact of 11 comorbid conditions on 10 outcomes (including surgical complications, readmissions, mortality, function, health-related quality of life, pain and revision surgery). The quality of included studies was assessed using a modified Newcastle-Ottawa Scale. Continuous outcomes were converted to ORs using the Hasselblad and Hedges approach. Results were combined using a random-effects meta-analysis. OUTCOMES: The primary outcome was the adjusted OR for the impact of each 11 comorbid condition on each of the 10 outcomes compared with patients without the comorbid condition. Where the adjusted OR was not available the secondary outcome was the crude OR.

results70 studies were included with 16 (23%) reporting on at least 100 000 patients and 9 (13%) were of high quality. We found that comorbidities increased the short-term risk of hospital readmissions (8 of 11 conditions) and mortality (8 of 11 conditions). The impact on surgical complications was inconsistent across comorbid conditions. In the long term, comorbid conditions increased the risk of revision surgery (6 of 11 conditions) and long-term mortality (7 of 11 conditions). The long-term impact on function, quality of life and pain varied across comorbid conditions.

conclusionsThis systematic review shows that comorbidities predominantly have an impact on the safety of hip and knee replacement surgery but little impact on its effectiveness. There is a need for high-quality studies also considering the severity of comorbid conditions.

Indexed as

Quality of LifeArthroplasty, Replacement, HipArthroplasty, Replacement, KneeComorbidityHumansPatient ReadmissionPostoperative ComplicationsRecovery of FunctionReoperationRisk Factorscomorbidityhipkneeoutcomessystematic review

Identifiers

PMID29997141
PMCPMC6082478

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.