Acute stroke after total joint arthroplasty: a population-based trend analysis.
OBJECTIVE
This study aims to determine trends and predictors of acute stroke among total joint arthroplasty (TJA) patients using nationally representative data.


METHODS
Retrospective database review.


METHODS
Nationwide Inpatient Sample database.


METHODS
A total of 1,762,496 TJAs from 2002 to 2011.


METHODS
Patients underwent primary or revision total hip or total knee arthroplasty.


METHODS
Development of perioperative acute stroke.


RESULTS
Among 1,762,496 TJAs, 2414 patients (0.14%) developed stroke; 1918 (79.45%) cases were ischemic and the remaining 496 (20.55%) cases were hemorrhagic stroke. The incidence of stroke decreased steadily from 0.17% in 2002 to 0.14% in 2011, which was statistically significant (P<.0001). The in-hospital mortality rate was much higher after stroke at 9% vs 0.15% for general TJA patients. Logistic regression analysis showed that stroke is a strong predictor of in-hospital mortality (odds ratio [OR], 27.73; 95% confidence interval [CI], 23.06-33.05; P<.001). Independent predictors of stroke were presence of pulmonary circulation disorders (including pulmonary embolism; OR, 2.23; 95% CI, 1.73-2.87), advanced diabetes mellitus (OR, 2.10; 95% CI, 1.61-2.73), cardiac arrhythmia (OR, 2.05; 95% CI, 1.83-2.29), peripheral vascular disease (OR, 1.74; 95% CI, 1.42-2.12), valvular heart disease (OR, 1.67; 95% CI, 1.43-1.95), renal disease (OR, 1.66; 95% CI, 1.38-1.99), and revision hip (OR, 1.39; 95% CI, 1.18-1.65). History of stroke or ischemic heart disease was not an independent predictor of stroke.


CONCLUSIONS
Despite a decline in the rate of stroke and stroke-related mortality after TJA, stroke still seems to be a major cause of in-hospital mortality. The present study outlines some risk factors for stroke after TJA. Recognition of these factors and identification of the at-risk patients may allow for appropriate allocation of resources and ability to minimize this complication after TJA.
Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA.
Mohammad R
MR
Rasouli
Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA.
Reza Mostafavi
RM
Tabatabaee
Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA.
Mitchell G
MG
Maltenfort
Investigation performed at the Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: antonia.chen@rothmaninstitute.com.
Antonia F
AF
Chen
D001145:Arrhythmias, Cardiac / Q000150:complications; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D048909:Diabetes Complications / Q000150:complications; D006349:Heart Valve Diseases / Q000150:complications; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000150:complications; D059035:Perioperative Period / Q000706:statistics & numerical data*; D016491:Peripheral Vascular Diseases / Q000150:complications; D011655:Pulmonary Embolism / Q000150:complications; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D014481:United States / Q000453:epidemiology
Nationwide Inpatient Sample; Stroke; Total joint arthroplasty