Cardiac and Thromboembolic Complications and Mortality in Patients Undergoing Total Hip and Total Knee Arthroplasty

Overview

Journal Ann Rheum Dis

Specialty Rheumatology

Date 2011 Oct 25

PMID 22021865

Citations 42

Authors

Jasvinder A Singh

Matthew R Jensen

William Scott Harmsen

Sherine E Gabriel

David G Lewallen

Affiliations

Soon will be listed here.

Abstract

Objective: To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA).

Method: In a population-based cohort of all Olmsted County residents who underwent a THA or TKA (1994-2008), we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis or pulmonary embolism) and mortality.

Results: 90-day complication rates after THA and TKA were: cardiac, 6.9% and 6.7%; thromboembolic, 4.0% and 4.9%; and mortality, 0.7% and 0.4%, respectively. In multivariable-adjusted logistic regression analyses, ASA class III-IV (OR 6.1, 95% CI:1.6-22.8) and higher Deyo-Charlson comorbidity score (OR 1.2, 95% CI:1.0-1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known previous cardiac event. In those with known previous cardiac disease, ASA class III-IV (OR 4.4, 95% CI:2.0-9.9), male gender (OR 0.5, 95% CI:0.3-0.9) and history of thromboembolic disease (OR 3.2; 95% CI:1.4-7.0) were significantly associated with odds of cardiac complication 90 days post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no previous cardiac history, age >65 years (OR 4.1, 95% CI:1.2-14.0) and in TKA patients with known cardiac disease, ASA class III-IV (OR 3.2, 95% CI:1.8-5.7) was significantly associated with odds of 90-day cardiac events. In TKA patients with no previous thromboembolic disease, male gender (OR 0.5, 95% CI:0.2-0.9) and higher Charlson index (OR 1.2, 95% CI:1.1-1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR 1.2, 95% CI:1.1-1.4) was associated with odds of 90-day thromboembolic events.

Conclusion: Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.

Citing Articles

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90-day readmission risk, but not in-hospital mortality is lower in female patients who undergo elective primary total hip arthroplasty for osteoarthritis.

Chandrupatla S, Singh J Clin Rheumatol. 2024; 43(12):4005-4008.

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Multiple risk factors are associated with an incremental increase in acute venous thromboembolism risk after total joint arthroplasty: A pearldiver cohort study.

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References

Howie C, Hughes H, Watts A . Venous thromboembolism associated with hip and knee replacement over a ten-year period: a population-based study. J Bone Joint Surg Br. 2005; 87(12):1675-80. DOI: 10.1302/0301-620X.87B12.16298. View

Codd M, Sugrue D, Gersh B, Melton 3rd L . Epidemiology of idiopathic dilated and hypertrophic cardiomyopathy. A population-based study in Olmsted County, Minnesota, 1975-1984. Circulation. 1989; 80(3):564-72. DOI: 10.1161/01.cir.80.3.564. View

Peterson L, Mason T, Nelson A, OFallon W, Gabriel S . Juvenile rheumatoid arthritis in Rochester, Minnesota 1960-1993. Is the epidemiology changing?. Arthritis Rheum. 1996; 39(8):1385-90. DOI: 10.1002/art.1780390817. View

St Sauver J, Hagen P, Cha S, Bagniewski S, Mandrekar J, Curoe A . Agreement between patient reports of cardiovascular disease and patient medical records. Mayo Clin Proc. 2005; 80(2):203-10. DOI: 10.4065/80.2.203. View

Shbeeb M, Uramoto K, Gibson L, OFallon W, Gabriel S . The epidemiology of psoriatic arthritis in Olmsted County, Minnesota, USA, 1982-1991. J Rheumatol. 2000; 27(5):1247-50. View

Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster J . Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am. 2004; 86(5):963-74. DOI: 10.2106/00004623-200405000-00012. View

Doran M, Crowson C, OFallon W, Hunder G, Gabriel S . Trends in the incidence of polymyalgia rheumatica over a 30 year period in Olmsted County, Minnesota, USA. J Rheumatol. 2002; 29(8):1694-7. View

Westrich G, Farrell C, Bono J, Ranawat C, Salvati E, Sculco T . The incidence of venous thromboembolism after total hip arthroplasty: a specific hypotensive epidural anesthesia protocol. J Arthroplasty. 1999; 14(4):456-63. DOI: 10.1016/s0883-5403(99)90101-8. View

Kim W, Benson J, Therneau T, Torgerson H, Yawn B, Melton 3rd L . Changing epidemiology of hepatitis B in a U.S. community. Hepatology. 2004; 39(3):811-6. DOI: 10.1002/hep.20098. View

10.

Kremers H, Myasoedova E, Crowson C, Savova G, Gabriel S, Matteson E . The Rochester Epidemiology Project: exploiting the capabilities for population-based research in rheumatic diseases. Rheumatology (Oxford). 2010; 50(1):6-15. PMC: 3716332. DOI: 10.1093/rheumatology/keq199. View

11.

St Sauver J, Grossardt B, Yawn B, Melton 3rd L, Rocca W . Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester epidemiology project. Am J Epidemiol. 2011; 173(9):1059-68. PMC: 3105274. DOI: 10.1093/aje/kwq482. View

12.

Peterson L, Nelson A, Su W, Mason T, OFallon W, Gabriel S . The epidemiology of morphea (localized scleroderma) in Olmsted County 1960-1993. J Rheumatol. 1997; 24(1):73-80. View

13.

Memtsoudis S, Gonzalez Della Valle A, Besculides M, Esposito M, Koulouvaris P, Salvati E . Risk factors for perioperative mortality after lower extremity arthroplasty: a population-based study of 6,901,324 patient discharges. J Arthroplasty. 2008; 25(1):19-26. DOI: 10.1016/j.arth.2008.11.010. View

14.

DRIPPS R, Lamont A, ECKENHOFF J . The role of anesthesia in surgical mortality. JAMA. 1961; 178:261-6. DOI: 10.1001/jama.1961.03040420001001. View

15.

Melton 3rd L . History of the Rochester Epidemiology Project. Mayo Clin Proc. 1996; 71(3):266-74. DOI: 10.4065/71.3.266. View

16.

Bambha K, Kim W, Talwalkar J, Torgerson H, Benson J, Therneau T . Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. Gastroenterology. 2003; 125(5):1364-9. DOI: 10.1016/j.gastro.2003.07.011. View

17.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

18.

Whittle J, Steinberg E, Anderson G, Herbert R, Hochberg M . Mortality after elective total hip arthroplasty in elderly Americans. Age, gender, and indication for surgery predict survival. Clin Orthop Relat Res. 1993; (295):119-26. View

19.

Perka C, Arnold U, Buttgereit F . Influencing factors on perioperative morbidity in knee arthroplasty. Clin Orthop Relat Res. 2000; (378):183-91. DOI: 10.1097/00003086-200009000-00028. View

20.

Berry D, Kessler M, Morrey B . Maintaining a hip registry for 25 years. Mayo Clinic experience. Clin Orthop Relat Res. 1997; (344):61-8. DOI: 10.1097/00003086-199711000-00007. View