title: Perioperative Risk in Patients With Epilepsy Undergoing Total Joint Arthroplasty.
abstract: Epilepsies is a spectrum of brain disorders ranging from severe, life threatening, and disabling to more benign, but little is known about its impact in the perioperative arthroplasty setting. We sought to determine whether epileptic patients undergoing elective total joint arthroplasty (TJA) would be at increased risk for in-hospital complications and death, prolonged stay, and nonroutine discharge.
  
  
  
  Using discharge records from the Nationwide Inpatient Sample (2002-2011), we identified 6,054,344 patients undergoing elective primary TJA, of whom 31,865 (0.5%) were identified as having epilepsy. Comparisons of perioperative outcomes were performed by multivariable logistic regression modeling.
  
  
  
  Patients with epilepsy were associated with increased in-hospital mortality (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.57-2.62) and morbidity, including (in decreasing order of magnitude of effect estimate): mechanical ventilation (OR 1.74, 95% CI 1.56-1.94), induced mental disorder (OR 1.70, 95% CI 1.56-1.85), stroke (OR 1.63, 95% CI 1.23-2.15), pneumonia (OR 1.34, 95% CI 1.21-1.49), and ileus or gastrointestinal events (OR 1.26, 95% CI 1.12-1.42). Epilepsy was associated with higher risk for blood transfusion (OR 1.30, 95% CI 1.27-1.33), prolonged hospital stay (OR 1.14, 95% CI 1.11-1.17), and nonroutine discharge (OR 1.54, 95% CI 1.50-1.58). We found no association with inpatient thromboembolic events, acute renal failure, and myocardial infarction.
  
  
  
  Patients with epilepsy are at increased risk for early postoperative complications (especially mechanical ventilation, induced mental disorder, and stroke) and resource utilization after elective joint arthroplasty. Greater awareness of epilepsy and its health consequences may contribute to improvements in the perioperative management of TJA patients.
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Cory G
authors.initials: CG
authors.lastname: Couch
authors.affiliation: Dell Medical School, The University of Texas at Austin, Austin, Texas.
authors.forename: Mariano E
authors.initials: ME
authors.lastname: Menendez
authors.affiliation: Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: C Lowry
authors.initials: CL
authors.lastname: Barnes
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D001803:Blood Transfusion; D003430:Cross-Sectional Studies; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004827:Epilepsy / Q000150:complications*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D014481:United States / Q000453:epidemiology
keywords: arthroplasty; complications; epilepsy; morbidity; outcomes; perioperative