title: Metabolic syndrome increases risk for pulmonary embolism after hip and knee arthroplasty.
abstract: OBJECTIVE
  To investigate whether patients with metabolic syndrome (MetS) undergoing total hip or knee replacement have an increased risk for pulmonary embolism (PE).
  
  
  METHODS
  We studied patients undergoing total hip or total knee replacement from January 2001 to April 2006. The diagnosis of PE was based on a positive finding with a chest CT or a lung scan. Components of MetS were defined as 1) BMI≥30 kg/m(2) , 2) non-fasting preadmission glucose ≥11.1 mmol/L or diagnosis of diabetes, 3) hypertension, and 4) dyslipidemia. MetS was diagnosed if at least three of these components were present.
  
  
  RESULTS
  Of 7282 patients, 107 (1.47%) were diagnosed with PE. The incidence of PE in patients with 0, 1, 2, 3, and 4 MetS components was respectively 0.85% (16/1888; 95% confidence interval [CI] 0.5%-1.4%), 1.24% (31/2500; 95% CI 0.9%-1.8%), 1.76% (34/1936; 95% CI 1.2%-2.5%), 2.64% (21/796; 95% CI 1.7%-4.1%), and 3.09% (5/162; 95% CI 1.1%-7.4%). The independent risk factors for PE were age ≥70, knee as opposite to hip replacement, bilateral knee surgery, congestive heart failure, and MetS or the number of MetS components. The odds of PE independently increased 1.6 times (95% CI 1.01-2.56; P=0.043) for patients with MetS and 1.23 times (95% CI 1.02-1.48; P=0.028) per each additional MetS component.
  
  
  CONCLUSIONS
  Patients with MetS are at increased risk for PE after total joint arthroplasty. The increasing number of MetS components significantly increased the incidence of PE.
authors.affiliation: Boris Mraovic, MD, Associate Professor, Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, 111 South 11th Street Suite G8280, Philadelphia, PA 19107, USA, bmraovic@hotmail.com.
authors.forename: Boris
authors.initials: B
authors.lastname: Mraovic
authors.forename: Brian R
authors.initials: BR
authors.lastname: Hipszer
authors.forename: Richard H
authors.initials: RH
authors.lastname: Epstein
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
authors.forename: Edward C
authors.initials: EC
authors.lastname: Pequignot
authors.forename: Inna
authors.initials: I
authors.lastname: Chervoneva
authors.forename: Jeffery I
authors.initials: JI
authors.lastname: Joseph
mesh_terms: D000328:Adult; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000601:surgery; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000601:surgery; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed