TY - JOUR
T1 - Incidence and Risk Factors for Stroke in Fast-Track Hip and Knee Arthroplasty
T2 - A Clinical Registry Study of 24,862 Procedures
AU - Petersen, Pelle B
AU - Kehlet, Henrik
AU - Jørgensen, Christoffer C
AU - Lundbeck Foundation Center for Fast-Track Hip and Knee Replacement Collaborative Group
N1 - Copyright © 2018 Elsevier Inc. All rights reserved.
PY - 2019/4
Y1 - 2019/4
N2 - BACKGROUND: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA.METHODS: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population.RESULTS: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P = .055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population.CONCLUSION: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.
AB - BACKGROUND: Postoperative stroke is a severe complication with a reported 30-day incidence of 0.4%-0.6% after total hip (THA) and knee arthroplasty (TKA). However, most data are based on diagnostic codes and with limited details on perioperative care, including the use of fast-track protocols. We investigated the incidence of and preoperative and postoperative factors for stroke after fast-track THA/TKA.METHODS: We used an observational study design of elective fast-track THA/TKA patients with prospective collection of comorbidity and complete 90-day follow-up. Medical records were evaluated for events potentially disposing to stroke. Identification of relevant preoperative risk factors was done by multivariable logistic regression. Incidence of stroke was compared with a Danish background population.RESULTS: Of 24,862 procedures with a median length of stay of 2 (interquartile range, 2-3) days, we found 27 (0.11%; 95% confidence interval [CI], 0.08%-0.16%) and 43 strokes (0.17%, 95% CI, 0.13%-0.23%) ≤30 and ≤90 days after surgery, respectively. Preoperative risk factors for stroke ≤30 days were age ≥ 85 years (odds ratio [OR], 4.3; 95% CI, 1.1-16.3) and anticoagulant treatment (OR, 3.1; 95% CI, 1.2-7.9). Preoperative anemia was near significant (OR, 2.1; 95% CI, 0.98-4.6, P = .055). Eight strokes ≤30 days were preceded by a cardiovascular event within the second postoperative day. Incidence of stroke after postoperative day 30 was similar to a Danish background population.CONCLUSION: Risk of postoperative stroke in fast-track THA and TKA was low but may be further reduced with increased focus on avoiding perioperative cardiovascular events and in patients with preoperative anticoagulants or anemia.
KW - Aged
KW - Aged, 80 and over
KW - Anemia/complications
KW - Anticoagulants/adverse effects
KW - Arthroplasty, Replacement, Hip/adverse effects
KW - Arthroplasty, Replacement, Knee/adverse effects
KW - Cohort Studies
KW - Comorbidity
KW - Denmark/epidemiology
KW - Elective Surgical Procedures
KW - Female
KW - Humans
KW - Incidence
KW - Length of Stay
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Odds Ratio
KW - Registries
KW - Risk Factors
KW - Stroke/epidemiology
U2 - 10.1016/j.arth.2018.12.022
DO - 10.1016/j.arth.2018.12.022
M3 - Journal article
C2 - 30665835
SN - 0883-5403
VL - 34
SP - 743-749.e2
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 4
ER -