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Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty
  1. Jasvinder A Singh1,2,3,4,
  2. Matthew R Jensen1,
  3. William Scott Harmsen1,
  4. Sherine E Gabriel1,
  5. David G Lewallen2
  1. 1Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
  2. 2Department of Orthopedic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
  3. 3Rheumatology Section, Medicine Service, VA Medical Center, Birmingham, Alabama, USA
  4. 4Division of Rheumatology, Department of Medicine, University of Alabama, Birmingham, Alabama, USA
  1. Correspondence to Jasvinder A Singh, Division of Rheumatology, Department of Medicine, University of Alabama, 510 20th Street, FOT 805B South, Birmingham, AL 35294, USA; Jasvinder.md{at}gmail.com

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.

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Footnotes

  • The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

  • Funding This study received funding from the NIH CTSA Award 1 KL2 RR024151-01 (Mayo Clinic Center for Clinical and Translational Research) and the Department of Orthopaedic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.

  • Competing interests One of the authors (DGL) has received royalties/speaker fees from Zimmer, has been a paid consultant to Zimmer and has received institutional research funds from DePuy, Stryker and Zimmer. JAS has received speaker honoraria from Abbott; research and travel grants from Allergan, Takeda, Savient, Wyeth and Amgen, and consultant fees from Savient, URL pharmaceuticals and Novartis.

  • Ethics approval This study was conducted with the approval of the Mayo Clinic. Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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