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New research · Internal Medicine
Seminars in thrombosis and hemostasis · 3h
Cohort studySeminars in thrombosis and hemostasis · 2026

Sex-Related Differences and Predictors of Mortality in Patients Undergoing Major Orthopaedic Surgery: Insights from the ORTHO-START Registry.

Elvira Grandone, Emilia Antonucci, Gregory Piazza … Maurizio Margaglione
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Internal MedicineCohort study

Male sex linked to more than double the odds of death after major orthopaedic surgery

Sex-Related Differences and Predictors of Mortality in Patients Undergoing Major Orthopaedic Surgery: Insights from the ORTHO-START Registry.

Elvira Grandone … Maurizio Margaglione
Seminars in thrombosis and hemostasis · 2026
Background

Sex-related differences in outcomes after major orthopaedic surgery remain under-investigated, and the prognostic relevance of a history of venous thromboembolism (venous thromboembolism) is unclear.

Methods

The ORTHO-START registry is a prospective, multicenter study including 1,077 consecutive adults undergoing major orthopaedic surgery (elective hip/knee arthroplasty or urgent hip fracture repair) across six Italian centers between July 2018 and March 2022.

n = 775
Results

men had over double the risk of dying within 2 years after surgery

OR by subgroup · 95% CI
null = 1
urgent surgery
7.20
prior VTE
5.70
More results

The primary outcome was all-cause mortality at 24 months; secondary outcomes were thromboembolic and bleeding events.

Multivariable logistic regression identified predictors of mortality.

Urgent procedures comprised 65.6% ( n = 706) of surgeries, predominantly involving women ( n = 542).

More results

Causes of death were known for 160/210 (76.2%): neurological complications were most frequent (25%), followed by cardiovascular disease (21.3%) and immobility-related causes (14.4%); pulmonary embolism accounted for 1.3% of deaths.

“
Conclusion

Incorporating these factors into preoperative risk assessment may improve management and postoperative outcomes.

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