Predictors of ischemic stroke after hip operation: a population-based study.
BACKGROUND
Hip operation (total hip arthroplasty [THA] or fracture repair) is the most common noncardiac surgical procedure performed in patients age 65 years and older.


OBJECTIVE
To determine the predictors of ischemic stroke in patients who have undergone hip operation.


METHODS
Population-based historical cohort study, in which postoperative ischemic strokes were identified from medical record review for stroke diagnostic codes and brain imaging results and were confirmed by physician review.


METHODS
Tertiary care center in Olmsted County, Minnesota.


METHODS
Residents of Olmsted County who underwent hip surgical procedure.


METHODS
Incidence of ischemic stroke within 1 year of hip operation.


RESULTS
In total, 1606 patients underwent 1886 hip procedures from 1988 through 2002 and were observed for ischemic stroke for 1 year after their procedure. Sixty-seven ischemic strokes were identified. The rate of stroke at 1 year after hip operation was 3.9%. In univariate analysis, history of atrial fibrillation (hazard ratio [HR], 2.16; P = 0.005), hip fracture repair vs. total hip arthroplasty (HR, 3.80; P < 0.001), age 75 years or older (HR, 2.20; P = 0.02), aspirin use (HR, 1.8; P = 0.01), and history of previous stroke (HR, 4.18; P < 0.001) were significantly associated with increased risk of stroke. In multivariable analysis, history of stroke (HR, 3.27; P < 0.001) and hip fracture repair (HR, 2.74; P = 0.004) were strong predictors of postoperative stroke.


CONCLUSIONS
This population-based historical cohort of patients with hip operation had a 3.9% cumulative probability of ischemic stroke over the first postoperative year. Hip fracture repair and history of stroke were the strongest predictors of this complication.
Popa
Alina S
AS
Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Rabinstein
Alejandro A
AA
Huddleston
Paul M
PM
Larson
Dirk R
DR
Gullerud
Rachel E
RE
Huddleston
Jeanne M
JM
D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications