Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty

Jasvinder A. Singh, Matthew R. Jensen, William Scott Harmsen, Sherine E. Gabriel, David G. Lewallen

Research output: Contribution to journalArticle

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Abstract

Objective: To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA). Method: In a population-based cohort of all Olmsted County residents who underwent a THA or TKA (1994- 2008), we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis or pulmonary embolism) and mortality. Results: 90-day complication rates after THA and TKA were: cardiac, 6.9% and 6.7%; thromboembolic, 4.0% and 4.9%; and mortality, 0.7% and 0.4%, respectively. In multivariable-adjusted logistic regression analyses, ASA class III-IV (OR 6.1, 95% CI:1.6-22.8) and higher Deyo- Charlson comorbidity score (OR 1.2, 95% CI:1.0-1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known previous cardiac event. In those with known previous cardiac disease, ASA class III-IV (OR 4.4, 95% CI:2.0-9.9), male gender (OR 0.5, 95% CI:0.3-0.9) and history of thromboembolic disease (OR 3.2; 95% CI:1.4-7.0) were significantly associated with odds of cardiac complication 90 days post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no previous cardiac history, age >65 years (OR 4.1, 95% CI:1.2-14.0) and in TKA patients with known cardiac disease, ASA class III-IV (OR 3.2, 95% CI:1.8-5.7) was significantly associated with odds of 90-day cardiac events. In TKA patients with no previous thromboembolic disease, male gender (OR 0.5, 95% CI:0.2-0.9) and higher Charlson index (OR 1.2, 95% CI:1.1-1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR 1.2, 95% CI:1.1-1.4) was associated with odds of 90-day thromboembolic events. Conclusion: Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.

Original languageEnglish (US)
Pages (from-to)2082-2088
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume70
Issue number12
DOIs
StatePublished - Dec 2011

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Arthroplasty
Knee Replacement Arthroplasties
Hip
Mortality
Heart Diseases
Comorbidity
Thromboembolism
Pulmonary Embolism
Venous Thrombosis
Cardiac Arrhythmias
Heart Failure
Logistic Models
History
Myocardial Infarction
Regression Analysis
Population
Logistics

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Allergy

Cite this

Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. / Singh, Jasvinder A.; Jensen, Matthew R.; Harmsen, William Scott; Gabriel, Sherine E.; Lewallen, David G.

In: Annals of the Rheumatic Diseases, Vol. 70, No. 12, 12.2011, p. 2082-2088.

Research output: Contribution to journalArticle

Singh, Jasvinder A. ; Jensen, Matthew R. ; Harmsen, William Scott ; Gabriel, Sherine E. ; Lewallen, David G. / Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. In: Annals of the Rheumatic Diseases. 2011 ; Vol. 70, No. 12. pp. 2082-2088.
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abstract = "Objective: To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA). Method: In a population-based cohort of all Olmsted County residents who underwent a THA or TKA (1994- 2008), we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis or pulmonary embolism) and mortality. Results: 90-day complication rates after THA and TKA were: cardiac, 6.9{\%} and 6.7{\%}; thromboembolic, 4.0{\%} and 4.9{\%}; and mortality, 0.7{\%} and 0.4{\%}, respectively. In multivariable-adjusted logistic regression analyses, ASA class III-IV (OR 6.1, 95{\%} CI:1.6-22.8) and higher Deyo- Charlson comorbidity score (OR 1.2, 95{\%} CI:1.0-1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known previous cardiac event. In those with known previous cardiac disease, ASA class III-IV (OR 4.4, 95{\%} CI:2.0-9.9), male gender (OR 0.5, 95{\%} CI:0.3-0.9) and history of thromboembolic disease (OR 3.2; 95{\%} CI:1.4-7.0) were significantly associated with odds of cardiac complication 90 days post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no previous cardiac history, age >65 years (OR 4.1, 95{\%} CI:1.2-14.0) and in TKA patients with known cardiac disease, ASA class III-IV (OR 3.2, 95{\%} CI:1.8-5.7) was significantly associated with odds of 90-day cardiac events. In TKA patients with no previous thromboembolic disease, male gender (OR 0.5, 95{\%} CI:0.2-0.9) and higher Charlson index (OR 1.2, 95{\%} CI:1.1-1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR 1.2, 95{\%} CI:1.1-1.4) was associated with odds of 90-day thromboembolic events. Conclusion: Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.",
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AU - Singh, Jasvinder A.

AU - Jensen, Matthew R.

AU - Harmsen, William Scott

AU - Gabriel, Sherine E.

AU - Lewallen, David G.

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N2 - Objective: To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA). Method: In a population-based cohort of all Olmsted County residents who underwent a THA or TKA (1994- 2008), we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis or pulmonary embolism) and mortality. Results: 90-day complication rates after THA and TKA were: cardiac, 6.9% and 6.7%; thromboembolic, 4.0% and 4.9%; and mortality, 0.7% and 0.4%, respectively. In multivariable-adjusted logistic regression analyses, ASA class III-IV (OR 6.1, 95% CI:1.6-22.8) and higher Deyo- Charlson comorbidity score (OR 1.2, 95% CI:1.0-1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known previous cardiac event. In those with known previous cardiac disease, ASA class III-IV (OR 4.4, 95% CI:2.0-9.9), male gender (OR 0.5, 95% CI:0.3-0.9) and history of thromboembolic disease (OR 3.2; 95% CI:1.4-7.0) were significantly associated with odds of cardiac complication 90 days post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no previous cardiac history, age >65 years (OR 4.1, 95% CI:1.2-14.0) and in TKA patients with known cardiac disease, ASA class III-IV (OR 3.2, 95% CI:1.8-5.7) was significantly associated with odds of 90-day cardiac events. In TKA patients with no previous thromboembolic disease, male gender (OR 0.5, 95% CI:0.2-0.9) and higher Charlson index (OR 1.2, 95% CI:1.1-1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR 1.2, 95% CI:1.1-1.4) was associated with odds of 90-day thromboembolic events. Conclusion: Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.

AB - Objective: To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA). Method: In a population-based cohort of all Olmsted County residents who underwent a THA or TKA (1994- 2008), we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis or pulmonary embolism) and mortality. Results: 90-day complication rates after THA and TKA were: cardiac, 6.9% and 6.7%; thromboembolic, 4.0% and 4.9%; and mortality, 0.7% and 0.4%, respectively. In multivariable-adjusted logistic regression analyses, ASA class III-IV (OR 6.1, 95% CI:1.6-22.8) and higher Deyo- Charlson comorbidity score (OR 1.2, 95% CI:1.0-1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known previous cardiac event. In those with known previous cardiac disease, ASA class III-IV (OR 4.4, 95% CI:2.0-9.9), male gender (OR 0.5, 95% CI:0.3-0.9) and history of thromboembolic disease (OR 3.2; 95% CI:1.4-7.0) were significantly associated with odds of cardiac complication 90 days post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no previous cardiac history, age >65 years (OR 4.1, 95% CI:1.2-14.0) and in TKA patients with known cardiac disease, ASA class III-IV (OR 3.2, 95% CI:1.8-5.7) was significantly associated with odds of 90-day cardiac events. In TKA patients with no previous thromboembolic disease, male gender (OR 0.5, 95% CI:0.2-0.9) and higher Charlson index (OR 1.2, 95% CI:1.1-1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR 1.2, 95% CI:1.1-1.4) was associated with odds of 90-day thromboembolic events. Conclusion: Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.

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