title: Morbidity and Mortality in Elective Total Knee Arthroplasty Following Surgical Care Improvement Project Guidelines.
abstract: Perioperative myocardial infarctions and cardiac complications are leading causes of mortality after noncardiac surgery. In an effort to improve patient safety, the Surgical Care Improvement Project (SCIP) implemented guidelines concerning administration of β-blockers therapy aimed to reduce cardiac complications.
  
  
  
  The Nationwide Inpatient Sample was queried for 759,819 elective total knee arthroplasties performed from 2003 to 2011. Incidence of cardiac complications, mortality, and risk factors for cardiac complications was determined before and after SCIP implementation.
  
  
  
  The incidence of cardiac events after total knee arthroplasty remained stable at 9%. The incidence and mortality of postoperative stroke, myocardial infarction, and cardiac arrest significantly decreased. Mortality after cardiac complications decreased by 50%.
  
  
  
  After the implementation of SCIP guidelines, there was a greater than 50% reduction in mortality and a significant decrease in fatal postoperative stroke, heart failure, and cardiac arrest.
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Bemenderfer
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina; Department of Research Biostatistics, Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Nigel L
authors.initials: NL
authors.lastname: Rozario
authors.affiliation: Department of Research Biostatistics, Dickson Advanced Analytics, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Charity G
authors.initials: CG
authors.lastname: Moore
authors.affiliation: Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina.
authors.forename: Madhav A
authors.initials: MA
authors.lastname: Karunakar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000401:mortality; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006323:Heart Arrest; D006331:Heart Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D006333:Heart Failure; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007431:Intraoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: arthroplasty; cardiac; complications; elective; knee; surgical care improvement project