Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty.
OBJECTIVE
To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA).


METHODS
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.


CONCLUSIONS
Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.
Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA. Jasvinder.md@gmail.com
Jasvinder A
JA
Singh
Matthew R
MR
Jensen
William Scott
WS
Harmsen
Sherine E
SE
Gabriel
David G
DG
Lewallen
D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D011183:Postoperative Complications; D012737:Sex Factors; D013923:Thromboembolism / Q000453:epidemiology*