title: Risk comparison of bleeding and ischemic perioperative complications after acute and elective orthopedic surgery in patients with cardiovascular disease.
abstract: BACKGROUND
  The study objective was to ascertain the incidence of bleeding and ischemic complications related to acute and planned orthopedic surgery in patients with known cardiovascular diseases.
  
  
  METHODS
  The study conducted between 2010 and 2013 enrolled 477 patients (289 women, 188 men) with a diagnosed cardiovascular disease or a history of thromboembolic event. Aside from gender, age, height and weight, the study observed other anamnestic data and perioperative laboratory test results that may impact on a bleeding or ischemic event.
  
  
  RESULTS
  Two hundred seventy-two (57 %) patients had acute surgery, and 205 (43 %) patients had elective surgery. Complications arose in 55 (11.6 %) patients, 32 (6.9 %) had bleeding complications, 19 (4.0 %) ischemic complications, and both complications were experienced by 4 (0.8 %) patients. Bleeding developed in 14 (5.1 %) patients who had acute surgery, and in 22 (10.7 %) who had elective surgery. Twenty-two (8.1 %) patients having acute surgery and one (0.1 %) undergoing elective surgery suffered from ischemic complications. The incidence of bleeding complications was significantly higher in elective surgery (p = 0.026, OR 2.22), and when adjusted (general anaesthesia, gender, and use of warfarin), the difference was even higher (p = 0.015, OR 2.44), whereas the occurrence of ischemic complications was significantly higher in acute surgery (p = 0.005, OR 18.0), and when adjusted (age), the difference remained significant (p = 0.044, OR 8.3).
  
  
  CONCLUSIONS
  The study noted a significantly higher incidence of bleeding complications in elective orthopedic surgery when compared with acute surgery. Conversely, the incidence of ischemic complications was significantly higher in patients having acute orthopedic surgery when compared with those operated on electively.
authors.affiliation: Department of Orthopedics and Traumatology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic. valer.dzupa@fnkv.cz.
authors.forename: V
authors.initials: V
authors.lastname: Džupa
authors.affiliation: Department of Anesthaesiology and Resuscitation, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Waldauf
authors.affiliation: Third Department of Internal Medicine, Cardiology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: Z
authors.initials: Z
authors.lastname: Moťovská
authors.affiliation: Third Department of Internal Medicine, Cardiology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Widimský
authors.affiliation: Third Department of Internal Medicine, Cardiology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Ondráková
authors.affiliation: Department of Orthopedics and Traumatology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: R
authors.initials: R
authors.lastname: Bartoška
authors.affiliation: Department of Orthopedics and Traumatology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Ježek
authors.affiliation: Department of Orthopedics and Traumatology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: T
authors.initials: T
authors.lastname: Lena
authors.affiliation: Department of Orthopedics and Traumatology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: O
authors.initials: O
authors.lastname: Popelka
authors.affiliation: Department of Orthopedics and Traumatology, Third Faculty of Medicine of Charles University and University Hospital Kralovske Vinohrady, Srobarova 50, 100 34, Prague, Czech Republic.
authors.forename: M
authors.initials: M
authors.lastname: Krbec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007511:Ischemia / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors
keywords: Ischemic complications; Long-term antiplatelet therapy; Perioperative bleeding