Abstract 687: Risk factors for cardiovascular complications following total joint replacement surgery.
Authors
JN Katz, F Basilico, G Sweeney, J Gaydos, D Skoniecki, EA Wright, E Losina.
Background
The authors examine the association of joint replacement surgery and a risk of cardiovascular complication. It is known that the leading indication for knee and hip replacement surgery in the United States is osteoarthritis. More than half a million such surgical procedures are performed each year in this case. Therefore both the therapeutic benefit as well as the potential untoward effects associated with this procedure is of particular import to the growing proportion of the American population with known osteoarthritis.
Methods
Utilizing the surgical experience at a single academic institution, at the Brigham and Women’s Hospital in Boston, the authors conducted a case-control study of 209 cases who underwent primary or revision knee or hip arthroplasty and sustained a postoperative cardiovascular complication in comparison to 209 controls who underwent the same surgical procedure but did not experience any subsequent cardiovascular adverse events. Such cardiovascular complications included myocardial infarction, congestive heart failure, unstable angina, arrhythmia or pulmonary embolus.
Results
The authors examined several clinical factors, both medical and surgical, related to both the antecedent cardiovascular morbidity profile of the patients as well as the nature of the surgical profile, as might distinguish the cases who developed a cardiovascular complication from the controls who did not. Notably, a history of arrhythmia [odds ratio (OR) 2.6; 95% confidence interval (CI) 1.5 – 4.3], history of known coronary disease/ heart attack, heart failure of valvular disease [OR 1.5; 95% CI 0.9 – 2.6] were related to increase in risk of cardiovascular complication. Similarly, revision surgery [OR 2.2; 95% CI 1.2 – 3.9] and bilateral surgery [OR 3.5; 95% 1.5 – 8.0] were each related to greater risk of cardiovascular complication of surgery
Conclusions
The authors conclude that two new predictors of postoperative complication, following joint replacement surgery were identified, being bilateral surgery and revision surgery.
Editorial Comment
The abstract is informative and of health services benefit in identifying those patients is heightened risk to develop a postoperative cardiovascular complication following knee and hip surgery. Importantly, this abstracts suggests that those patients being evaluated for replacement surgery ought to be first evaluated by the cardiology service and perhaps to be routinely followed in the postoperative period by the cardiology service to identify and intervene rapidly should any untoward cardiovascular event occur. Similarly, in the patient population being identified for replacement surgery, it might be good policy to minimize the conduct of simultaneous bilateral surgery inasmuch as the performance of bilateral surgery at one setting was associated with the high risk ratio of a cardiovascular complication.
The abstract itself does not quantify how frequent such postoperative cardiovascular complications are. It would be interesting to undertake a stratified analysis by site of joint replacement. It may not be the case that patients who undergo knee replacement surgery face the same proportion of cardiovascular complication as those who undergo hip replacement.
