title: Influence of preoperative cardiovascular risk factor clusters on complications of total joint arthroplasty.
abstract: Identification of preexisting cardiovascular risk factors is important in projecting postoperative outcomes. Using claims data for 16,317 patients who underwent total hip arthroplasty and/or total knee arthroplasty, we performed logistic regression and survival analysis to determine the effects of hypertension, diabetes, dyslipidemia,and obesity (both independently and in clusters) on incidence of myocardial infarction (MI), venous thromboembolism (VTE), and revision arthroplasty. Our results indicated that diabetes (odds ratio [OR],1.55; P<.05) and hypertension (OR, 1.56; P<.05) were independent risk factors for postoperative MI. Risk for MI increased significantly with the addition of each risk factor; there was a 128% increase in risk when all 4 cardiovascular risk factors were present (OR, 2.28; P<.0001). Risk for VTE did not change significantly with 1, 2, or 3 risk factors but reached statistical significance when all 4 risk factors were present (hazard ratio, 3.20; P = .05). There was no association between cardiovascular risk factors and incidence of revision arthroplasty. Our analysis confirmed that diabetes and hypertension are risk factors for postoperative MI, but the respective significant and near significant increased risks for MI and VTE seen with cardiovascular risk factor clustering merit further evaluation of the role of metabolic syndrome in patients who undergo arthroplasty.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA. dyc@hss.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Dy
authors.forename: James D
authors.initials: JD
authors.lastname: Wilkinson
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tamariz
authors.forename: Sean P
authors.initials: SP
authors.lastname: Scully
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D048909:Diabetes Complications; D050171:Dyslipidemias / Q000150:complications*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D016896:Treatment Outcome