Perioperative cardiopulmonary events in patients undergoing total hip or knee arthroplasty

C. B. Mantilla, T. T. Horlocker, D. L. Brown, D. J. Berry, D. R. Schroeder

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1 Scopus citations

Abstract

Introduction The increasing elderly population in the United States is changing medical practice, and surgical procedures are being performed with more frequency in patients with serious coexisting disease. In this population segment some degree of cardiac, pulmonary , cerebral, renal and hepatic disease is commonly seen(1). The number of perioperative complications is not only dependent on the patient's pre-existing comorbidities, but also on the surgery and overall preoperative, operative and postoperative care (2). The study of possible complicating risk factors would allow potential modification of perioperative therapies to improve quality of care and optimize patient outcomes. Methods After IRB approval, two prospectively collected databases were used to identify all patients who underwent total hip or knee arthroplasty from January 1, 1986 to December 31, 1995 and who experienced an adverse cardiac or pulmonary complication in the perioperative period. For patients who underwent more than one arthroplasty during the study period the latest procedure was considered. The medical records of all patients identified as having a diagnosis of myocardial infarction, pulmonary embolism, deep venous thrombosis or death during the first 30 days postoperatively were retrospectively reviewed. Demographic data and information on co-morbid disease, medications and laboratory results were noted. Surgical procedure, anesthetic technique, and surgical, anesthetic, and recovery times were recorded. Additional intraoperative and immediately postoperative information including monitoring used, amount and type of administered fluids and occurrence of arrhythmia, hypo- or hypertension, ischemia and desaturation was noted. Postoperative disposition and in hospital anticoagulation, analgesia and duration of stay were recorded. Occurrence of an adverse event (myocardial infarction, pulmonary embolism, deep venous thrombosis and/or death) was reviewed and strict validation criteria were used for those within 30 days of the index surgery: Myocardial infarction (MI: two out of three: 1)CK-MB isoenzyme >3x upper limit of normal; 2)new ECG changes; or 3)a new wall motion abnormality); Pulmonary embolism (PE: new CXR, ventilation/perfusion scan or angiographie evidence of pulmonary infarct); Deep venous thrombosis (DVT: new thrombus in lower extremities demonstrated by doppler ultrasound, IPG or venography). Results A total of 14,394 patients (6597 males, 7797 females, mean age of 67.3 years) underwent total hip or knee joint replacement surgery in the period of study. 285 patients had one or more adverse events documented as above (definite event group) corresponding to an overall event rate of 2.0% (MI: 0.4%, PE: 0.5%, DVT: 0.6% and death 0.8%) (Table 1). The mean age of the 285 patients (143 males, 142 females) was 74.2 years (range 35, 99). 51.4% of patients received general anesthesia, 44.0% received spinal/epidural and 4.6% combined regional/general anesthetic. Table 1. Frequency and Timing of Perioperative Cardiopulmonary Event Timing Postop within 30 days Total frequency Intraoperative In hospital After discharge Event n % 95% C.I. n n n MI 59 0.4 0.3 to 0.5% 12 43 4 PE 73 0.5 0.4 to 0.6% 3 62 8 DVT 79 0.6 0.4 to 0.7% l 58 20 Death 114 0.8 0.7 to 1.0% 7 84 23 Discussion The overall frequency of serious perioperative complications following total hip or knee arthroplasty was found to be 2% (95% confidence interval: 1.8-2.2%). Available literature reports rely on high risk surgical procedures. We report significant cardiopulmonary morbidity following major orthopedic surgery.

Original languageEnglish (US)
Number of pages1
JournalRegional Anesthesia and Pain Medicine
Volume23
Issue number3 SUPPL.
StatePublished - Dec 1 1998

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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